Provider Demographics
NPI:1912194176
Name:ROGERS, KRISTINA RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RAE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 KEYSTONE XING STE 750
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7655
Mailing Address - Country:US
Mailing Address - Phone:317-573-1533
Mailing Address - Fax:502-508-6429
Practice Address - Street 1:8888 KEYSTONE XING STE 750
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7655
Practice Address - Country:US
Practice Address - Phone:317-573-1533
Practice Address - Fax:502-508-6429
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019090A183500000X
COPHA-17590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist