Provider Demographics
NPI:1104062132
Name:ST.CLAIR, ROGER DALE JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DALE
Last Name:ST.CLAIR
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10448 LAKERIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-8124
Mailing Address - Country:US
Mailing Address - Phone:804-550-4859
Mailing Address - Fax:
Practice Address - Street 1:2015 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3108
Practice Address - Country:US
Practice Address - Phone:804-354-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034094183500000X
GA025333183500000X
VA0202208333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist