Provider Demographics
NPI:1356560478
Name:ROGER, JARROD JOSEPH (PD)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:JOSEPH
Last Name:ROGER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HALE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5603
Mailing Address - Country:US
Mailing Address - Phone:985-438-0055
Mailing Address - Fax:
Practice Address - Street 1:7869 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4461
Practice Address - Country:US
Practice Address - Phone:985-873-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist