Provider Demographics
NPI:1124628227
Name:ROGOFF, CODY (PHARMD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:ROGOFF
Suffix:
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 1:106 SIERRA VALLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5945
Mailing Address - Country:US
Mailing Address - Phone:501-472-8383
Mailing Address - Fax:
Practice Address - Street 1:12001 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-7274
Practice Address - Country:US
Practice Address - Phone:501-854-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist