Provider Demographics
NPI:1700126992
Name:RODGERS, THOMAS GILLARA
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GILLARA
Last Name:RODGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2223
Mailing Address - Country:US
Mailing Address - Phone:251-341-5749
Mailing Address - Fax:251-545-4174
Practice Address - Street 1:4628 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2223
Practice Address - Country:US
Practice Address - Phone:251-341-5749
Practice Address - Fax:251-545-4174
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALP17212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist