Healthcare Provider Details

I. General information

NPI: 1750742078
Provider Name (Legal Business Name): LAUREN ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 SUMMIT ST
ELGIN IL
60120-4320
US

IV. Provider business mailing address

120 S REUTER DR
ARLINGTON HEIGHTS IL
60005-1504
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-7467
  • Fax:
Mailing address:
  • Phone: 847-259-4781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.287776
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: