Healthcare Provider Details

I. General information

NPI: 1700502978
Provider Name (Legal Business Name): DAMIAN ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17615 140TH AVE SE
RENTON WA
98058-6828
US

IV. Provider business mailing address

17331 SE 134TH ST
RENTON WA
98059-7049
US

V. Phone/Fax

Practice location:
  • Phone: 425-204-1585
  • Fax:
Mailing address:
  • Phone: 206-852-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: