Provider Demographics
NPI:1154870012
Name:POWERS, ROGER (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1123
Mailing Address - Country:US
Mailing Address - Phone:606-549-0449
Mailing Address - Fax:606-549-3233
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1123
Practice Address - Country:US
Practice Address - Phone:606-549-0449
Practice Address - Fax:606-549-3233
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist