Provider Demographics
NPI:1669880704
Name:ROGERS, LAURA J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 DALE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5403
Mailing Address - Country:US
Mailing Address - Phone:606-481-1178
Mailing Address - Fax:
Practice Address - Street 1:31 BIG HILL DR
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-8725
Practice Address - Country:US
Practice Address - Phone:606-464-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist