Provider Demographics
NPI:1528108420
Name:RODGERS, WILLIAM HARRY (DPH)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARRY
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15580
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3110
Mailing Address - Country:US
Mailing Address - Phone:904-798-4702
Mailing Address - Fax:904-353-2198
Practice Address - Street 1:921 N DAVIS ST
Practice Address - Street 2:BUILDING A, SUITE 160
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6804
Practice Address - Country:US
Practice Address - Phone:904-798-4702
Practice Address - Fax:904-353-2198
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24655183500000X
KY7253183500000X
GARPH016036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist