Provider Demographics
NPI:1811902463
Name:S R ROGERS INC
Entity type:Organization
Organization Name:S R ROGERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-697-7500
Mailing Address - Street 1:1601 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6549
Mailing Address - Country:US
Mailing Address - Phone:432-684-4797
Mailing Address - Fax:432-684-5757
Practice Address - Street 1:1601 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6549
Practice Address - Country:US
Practice Address - Phone:432-684-4797
Practice Address - Fax:432-684-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX199443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144935Medicaid
4527086OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4225050001Medicare NSC