Healthcare Provider Details

I. General information

NPI: 1588950380
Provider Name (Legal Business Name): MICHELLE NICOLE ROGERS PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CORWIN NIXON BLVD TARGET PHARMACY STORE NUMBER T2486
SOUTH LEBANON OH
45065-1196
US

IV. Provider business mailing address

400 CORWIN NIXON BLVD TARGET PHARMACY STORE NUMBER T2486
SOUTH LEBANON OH
45065-1196
US

V. Phone/Fax

Practice location:
  • Phone: 513-494-0701
  • Fax: 513-494-0711
Mailing address:
  • Phone: 513-494-0701
  • Fax: 513-494-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03228201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: