Provider Demographics
NPI:1700160660
Name:ROGERS, WARREN B JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:B
Last Name:ROGERS
Suffix:JR
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 1:303 MILLSTONE RD EAST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3225
Mailing Address - Country:US
Mailing Address - Phone:860-444-0812
Mailing Address - Fax:
Practice Address - Street 1:303 MILLSTONE RD EAST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-3225
Practice Address - Country:US
Practice Address - Phone:860-444-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist