Provider Demographics
NPI:1265715437
Name:HARGREAVES, ROGER J JR
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:J
Last Name:HARGREAVES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W290N7396 BARK RIVER CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8339
Mailing Address - Country:US
Mailing Address - Phone:262-369-0744
Mailing Address - Fax:
Practice Address - Street 1:W227N6103 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3969
Practice Address - Country:US
Practice Address - Phone:414-566-8005
Practice Address - Fax:414-566-8015
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist