=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861116410
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOUSTON L ROGERS JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2022
-----------------------------------------------------
Last Update Date | 09/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 BLUE RIDGE DR
-----------------------------------------------------
City | MC CAYSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30555-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-492-4126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 338
-----------------------------------------------------
City | MC CAYSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30555-0338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-492-4126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH018423
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------