Healthcare Provider Details

I. General information

NPI: 1558379925
Provider Name (Legal Business Name): SHANNON ELIZABETH ROGERS PHARM.D., BCGP, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/16/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 WEST THIRD STREET PHARMACY DEPARTMENT
DAYTON OH
45428-9000
US

IV. Provider business mailing address

4100 WEST THIRD STREET PHARMACY DEPARTMENT
DAYTON OH
45428-9000
US

V. Phone/Fax

Practice location:
  • Phone: 765-506-7100
  • Fax: 937-267-3315
Mailing address:
  • Phone: 765-506-7100
  • Fax: 937-267-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number1263
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3100857
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020197A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: