Provider Demographics
NPI:1811588676
Name:ROGERS, DANIEL SCOTT (PHTC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-2208
Mailing Address - Country:US
Mailing Address - Phone:912-654-3031
Mailing Address - Fax:912-654-1779
Practice Address - Street 1:703 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-2208
Practice Address - Country:US
Practice Address - Phone:912-654-3031
Practice Address - Fax:912-654-1779
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC002790183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician