Provider Demographics
NPI:1396713939
Name:ROGERS, WILLIAM R (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:ROGERS
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 1:118 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-1851
Mailing Address - Country:US
Mailing Address - Phone:706-376-5121
Mailing Address - Fax:706-376-6983
Practice Address - Street 1:118 ATHENS ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1851
Practice Address - Country:US
Practice Address - Phone:706-376-5121
Practice Address - Fax:706-376-6983
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00463713Medicaid
GA0497950001Medicare ID - Type Unspecified
GA00463713Medicaid