Provider Demographics
NPI:1720114515
Name:ROGERS, W. OWEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:W.
Middle Name:OWEN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:OWEN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:9611 E MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2248
Mailing Address - Country:US
Mailing Address - Phone:480-354-1605
Mailing Address - Fax:
Practice Address - Street 1:3185 W APACHE TRL
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3687
Practice Address - Country:US
Practice Address - Phone:480-288-2728
Practice Address - Fax:480-288-2730
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7699OtherPHARMACIST LISCENSE #