Provider Demographics
NPI:1447539549
Name:ROGERS, NATHAN JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:ROGERS
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 1:101 SANFORD FARMS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7535
Mailing Address - Country:US
Mailing Address - Phone:518-843-6895
Mailing Address - Fax:
Practice Address - Street 1:101 SANFORD FARMS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7535
Practice Address - Country:US
Practice Address - Phone:518-843-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist