Provider Demographics
NPI:1194114017
Name:ROGERS, BRIAN WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:ROGERS
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 1:175 S MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1623
Mailing Address - Country:US
Mailing Address - Phone:267-573-4555
Mailing Address - Fax:267-573-4966
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1623
Practice Address - Country:US
Practice Address - Phone:267-573-4555
Practice Address - Fax:267-573-4966
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045359L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist