Provider Demographics
NPI:1295163707
Name:ROGERS, MARIAN TESVICH (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:TESVICH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:TESVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8443 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2529
Mailing Address - Country:US
Mailing Address - Phone:504-393-1648
Mailing Address - Fax:
Practice Address - Street 1:8443 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2529
Practice Address - Country:US
Practice Address - Phone:504-393-1648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist