Provider Demographics
NPI:1336970102
Name:ROGALEWICZ, CARLA ANN
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANN
Last Name:ROGALEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 SWETLAND ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-1335
Mailing Address - Country:US
Mailing Address - Phone:570-335-8203
Mailing Address - Fax:
Practice Address - Street 1:2712 SWETLAND ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-1335
Practice Address - Country:US
Practice Address - Phone:570-335-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043514L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist