Provider Demographics
NPI:1336351097
Name:ELEBRA, ROGERS E A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROGERS
Middle Name:E A
Last Name:ELEBRA
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 1:4574 LARME AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3109
Mailing Address - Country:US
Mailing Address - Phone:313-724-3455
Mailing Address - Fax:313-724-3456
Practice Address - Street 1:DETROIT HEALTH DEPART - PHARMACY
Practice Address - Street 2:1151 TAYLOR STREET, 41 B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4013
Practice Address - Fax:313-876-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist