Provider Demographics
NPI:1871820894
Name:RODGERS, STEVEN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CAPITOL SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZIA PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87053-6013
Mailing Address - Country:US
Mailing Address - Phone:505-867-5258
Mailing Address - Fax:
Practice Address - Street 1:155 CAPITOL SQUARE DR
Practice Address - Street 2:
Practice Address - City:ZIA PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87053-6013
Practice Address - Country:US
Practice Address - Phone:505-867-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist