Healthcare Provider Details

I. General information

NPI: 1972701225
Provider Name (Legal Business Name): TRACY DEANE ROGERS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4794 HIGHWAY 162
HOLLYWOOD SC
29449-5740
US

IV. Provider business mailing address

104 HAMPTON DR
SUMMERVILLE SC
29485-8404
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-6522
  • Fax:
Mailing address:
  • Phone: 843-870-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9151
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: