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NPI Code Detail

MEDICARE: ROGER A BECKER RPH

MEDICARE: ROGER A BECKER RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS 28163FL

General Provider Information

NPI Number : 1225250228
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER A BECKER RPH
Provider Business Mailing Address
First Line : 120 GRAND HERON DRIVE
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32407-2401
Country : US
Telephone Number : 850-233-6684
Fax Number : 850-233-0474
Provider Business Practice Location Address
First Line : 3157 WEST 23RD STREET
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-1828
Country : US
Telephone Number : 850-747-0777
Fax Number : 850-747-9010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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