Healthcare Provider Details

I. General information

NPI: 1326968033
Provider Name (Legal Business Name): KEVIN ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 SOUTHLAND DR
MIDDLEBURG HEIGHTS OH
44130-3608
US

IV. Provider business mailing address

25212 CHASE DR
NORTH OLMSTED OH
44070-1221
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-3019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: