Provider Demographics
NPI:1811175359
Name:ROGERS, LISA FENTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:FENTON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 RANCHO BERNARDO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2073
Mailing Address - Country:US
Mailing Address - Phone:858-674-2365
Mailing Address - Fax:858-674-2364
Practice Address - Street 1:11939 RANCHO BERNARDO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2073
Practice Address - Country:US
Practice Address - Phone:858-674-2365
Practice Address - Fax:858-674-2364
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist