MEDICARE: DAVID ROLAND ROGERS PHARMACIST

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	28275	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28275	OTHER	CA	CALIFORNIA STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1528501467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROLAND ROGERS PHARMACIST

Provider Business Mailing Address
First Line	:	6301 MISTY WOOD WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-3504
Country	:	US
Telephone Number	:	916-622-7323
Fax Number	:	916-723-4228

Provider Business Practice Location Address
First Line	:	6301 MISTY WOOD WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-3504
Country	:	US
Telephone Number	:	916-622-7323
Fax Number	:	916-723-4228

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

Provider Enumeration Date	:	11/26/2016
Last Update Date	:	11/26/2016

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