Healthcare Provider Details

I. General information

NPI: 1659976587
Provider Name (Legal Business Name): MARIE ROGERS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701-4768
US

IV. Provider business mailing address

306 5TH AVE SW
SURREY ND
58785-7169
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7900
  • Fax:
Mailing address:
  • Phone: 701-720-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTECH778
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: