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General NPI Number Information
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NPI Number | 1801997937
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Entity Type | Organization
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Legal Business Name | BRUCE W ROGERS
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 4402 N LAURENT ST
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City | VICTORIA
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State | TX
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Zip | 77901-2742
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Country | US
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Telephone | 361-578-3521
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Fax | 361-576-5989
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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 | 361-578-3521
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Fax | 361-576-5989
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE WILSON ROGERS
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Credential | R.PH.
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Telephone | 361-578-3521
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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 | #4368
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License Number State | TX
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