Provider Demographics
NPI:1215338553
Name:ROGERS, RYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
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 1:720 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5500
Mailing Address - Country:US
Mailing Address - Phone:913-250-3504
Mailing Address - Fax:913-250-3508
Practice Address - Street 1:720 EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5500
Practice Address - Country:US
Practice Address - Phone:913-250-3504
Practice Address - Fax:913-250-3508
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist