Healthcare Provider Details

I. General information

NPI: 1275574873
Provider Name (Legal Business Name): M. ROGERS, INC. & SUBSIDIARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 STATE ST
MOUND CITY MO
64470-1146
US

IV. Provider business mailing address

607 STATE ST
MOUND CITY MO
64470-1146
US

V. Phone/Fax

Practice location:
  • Phone: 660-442-3355
  • Fax: 660-442-3601
Mailing address:
  • Phone: 660-442-3355
  • Fax: 660-442-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number003601
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number003601
License Number StateMO

VIII. Authorized Official

Name: MR. BENNE ROGERS
Title or Position: CFO
Credential:
Phone: 660-442-5694