Healthcare Provider Details

I. General information

NPI: 1467904243
Provider Name (Legal Business Name): DUSTEN ROGERSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 LAKE BLVD STE B
REDDING CA
96003-2504
US

IV. Provider business mailing address

317 LAKE BLVD STE B
REDDING CA
96003-2504
US

V. Phone/Fax

Practice location:
  • Phone: 530-351-7050
  • Fax: 530-351-7055
Mailing address:
  • Phone: 530-351-7050
  • Fax: 530-351-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: