Provider Demographics
NPI:1255410205
Name:PENROD, ROGER PAUL (RPH)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:PAUL
Last Name:PENROD
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 1:10287 HALFHITCH CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2581
Mailing Address - Country:US
Mailing Address - Phone:907-306-0546
Mailing Address - Fax:907-344-7305
Practice Address - Street 1:8900 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2022
Practice Address - Country:US
Practice Address - Phone:907-344-7300
Practice Address - Fax:907-344-7305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist