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General NPI Number Information
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NPI Number | 1356482996
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Entity Type | Organization
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Legal Business Name | ROGERS PHARMACY #4
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 6502 NURSERY DR SUITE 102
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City | VICTORIA
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State | TX
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Zip | 77904-1178
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Country | US
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Telephone | 361-572-0226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3670
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City | VICTORIA
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State | TX
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Zip | 77903-3670
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Country | US
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Telephone | 361-576-6599
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE WILSON ROGERS
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Credential |
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Telephone | 361-576-6599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 17588
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License Number State | TX
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