Provider Demographics
NPI:1447359153
Name:MCDERMOTT, ROGER PATRICK (RPH)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:PATRICK
Last Name:MCDERMOTT
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 1:1521 NE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1317
Mailing Address - Country:US
Mailing Address - Phone:954-816-0929
Mailing Address - Fax:
Practice Address - Street 1:1035 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6220
Practice Address - Country:US
Practice Address - Phone:954-763-5454
Practice Address - Fax:954-763-8206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist