Provider Demographics
NPI:1447520614
Name:TEST, ROGER E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:TEST
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:PO BOX 980730
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-0730
Mailing Address - Country:US
Mailing Address - Phone:435-785-8365
Mailing Address - Fax:
Practice Address - Street 1:909 E 2100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2321
Practice Address - Country:US
Practice Address - Phone:801-463-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327425-1701183500000X
TX18573183500000X
CO13655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist