MEDICARE: AMANDA ROGERS PHARMD.

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	53274	TX

General Provider Information

NPI Number	:	1790166007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROGERS PHARMD.

Provider Business Mailing Address
First Line	:	6700 WEST FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2160
Country	:	US
Telephone Number	:	817-377-8078
Fax Number	:	817-377-8452

Provider Business Practice Location Address
First Line	:	6700 WEST FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-2160
Country	:	US
Telephone Number	:	817-377-8078
Fax Number	:	817-377-8452

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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