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NPI Code Detail

MEDICARE: ROGER PAUL PENROD RPH

MEDICARE: ROGER PAUL PENROD 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
1183500000XPharmacist957AK

General Provider Information

NPI Number : 1255410205
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER PAUL PENROD RPH
Provider Business Mailing Address
First Line : 10287 HALFHITCH CIR
Second Line :
City : ANCHORAGE
State : AK
Zip : 99515-2581
Country : US
Telephone Number : 907-306-0546
Fax Number : 907-344-7305
Provider Business Practice Location Address
First Line : 8900 OLD SEWARD HWY
Second Line :
City : ANCHORAGE
State : AK
Zip : 99515-2022
Country : US
Telephone Number : 907-344-7300
Fax Number : 907-344-7305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 12/31/2009

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Directions to “ ROGER PAUL PENROD RPH” Practice Location

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