Provider Demographics
NPI:1851692057
Name:ROGITZ, LEO (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
Last Name:ROGITZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W BELL RD
Mailing Address - Street 2:FRY'S PHARMACY
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3059
Mailing Address - Country:US
Mailing Address - Phone:602-896-2533
Mailing Address - Fax:602-896-2527
Practice Address - Street 1:2727 W BELL RD
Practice Address - Street 2:FRY'S PHARMACY
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3059
Practice Address - Country:US
Practice Address - Phone:602-896-2533
Practice Address - Fax:602-896-2527
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS007259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist