Provider Demographics
NPI:1124677653
Name:AN, RODGER (PHARMD)
Entity type:Individual
Prefix:
First Name:RODGER
Middle Name:
Last Name:AN
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 1:1700 CERRILLOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3026
Mailing Address - Country:US
Mailing Address - Phone:505-946-9387
Mailing Address - Fax:
Practice Address - Street 1:400 SOLDIER CREEK DR
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-8502
Practice Address - Country:US
Practice Address - Phone:605-747-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist