MEDICARE: SHANNON ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44771	TX

General Provider Information

NPI Number	:	1457688764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ROGERS

Provider Business Mailing Address
First Line	:	4500 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4924
Country	:	US
Telephone Number	:	817-485-2547
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4924
Country	:	US
Telephone Number	:	817-485-2547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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Directions to “ SHANNON ROGERS ” Practice Location

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