Healthcare Provider Details

I. General information

NPI: 1194183467
Provider Name (Legal Business Name): M ROGERS INC & SUBSIDIARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E SOUTH AVE
MARYVILLE MO
64468-2669
US

IV. Provider business mailing address

125 E SOUTH AVE
MARYVILLE MO
64468-2669
US

V. Phone/Fax

Practice location:
  • Phone: 660-562-2300
  • Fax: 660-224-0259
Mailing address:
  • Phone: 660-562-2300
  • Fax: 660-224-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2015044910
License Number StateMO

VIII. Authorized Official

Name: BENNE ROGERS
Title or Position: OWNER
Credential:
Phone: 660-562-2300