Provider Demographics
NPI:1336462217
Name:ROSICKI, RODGER (RPH)
Entity type:Individual
Prefix:
First Name:RODGER
Middle Name:
Last Name:ROSICKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 POND PATH
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2006
Mailing Address - Country:US
Mailing Address - Phone:631-585-4469
Mailing Address - Fax:631-585-4331
Practice Address - Street 1:260 POND PATH
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-2006
Practice Address - Country:US
Practice Address - Phone:631-585-4469
Practice Address - Fax:631-585-4331
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist