Provider Demographics
NPI:1154341501
Name:ROGER F HARWICH CHARLES W ROGERS SIDNEY HUGHES ETAL
Entity type:Organization
Organization Name:ROGER F HARWICH CHARLES W ROGERS SIDNEY HUGHES ETAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZABOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-454-3680
Mailing Address - Street 1:859 MANKATO AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6435
Mailing Address - Country:US
Mailing Address - Phone:507-457-7688
Mailing Address - Fax:507-457-8598
Practice Address - Street 1:859 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6435
Practice Address - Country:US
Practice Address - Phone:507-457-7688
Practice Address - Fax:507-457-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20032673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN031858200Medicaid
WI33111300Medicaid
MN031858200Medicaid