MEDICARE: JESSICA RAE ROGERS PHARMD

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
1	183500000X	Pharmacist	5302032980	MI

General Provider Information

NPI Number	:	1417085549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RAE ROGERS PHARMD

Provider Business Mailing Address
First Line	:	5970 AVALON DR
Second Line	:	APT 225
City	:	MUSKEGON
State	:	MI
Zip	:	49444-7760
Country	:	US
Telephone Number	:	231-750-4059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 LAKE AVE
Second Line	:
City	:	NORTH MUSKEGON
State	:	MI
Zip	:	49445-3323
Country	:	US
Telephone Number	:	231-744-2401
Fax Number	:	231-744-9951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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