Provider Demographics
NPI:1780974535
Name:RODGERS, BRUCE ALAN (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:RODGERS
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2019
Mailing Address - Country:US
Mailing Address - Phone:937-258-8101
Mailing Address - Fax:937-258-1468
Practice Address - Street 1:2532 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2019
Practice Address - Country:US
Practice Address - Phone:937-258-8101
Practice Address - Fax:937-258-1468
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist