Provider Demographics
NPI:1669894077
Name:RODGERS, LILY ANN (RPH)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:ANN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29315 N 140TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-5505
Mailing Address - Country:US
Mailing Address - Phone:602-618-1616
Mailing Address - Fax:
Practice Address - Street 1:5605 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1332
Practice Address - Country:US
Practice Address - Phone:623-934-7926
Practice Address - Fax:623-934-7929
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08277183500000X
NM03994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03994OtherREGISTERED PHARMACIST
AZ08277OtherREGISTERED PHARMACIST