Provider Demographics
NPI:1700813235
Name:RODGERS, MARY JANE (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W FOURTH ST
Mailing Address - Street 2:EASTERN STATE HOSPITAL- PHARMACY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1294
Mailing Address - Country:US
Mailing Address - Phone:859-246-7241
Mailing Address - Fax:859-246-7023
Practice Address - Street 1:627 W FOURTH ST
Practice Address - Street 2:EASTERN STATE HOSPITAL- PHARMACY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1294
Practice Address - Country:US
Practice Address - Phone:859-246-7241
Practice Address - Fax:859-246-7023
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist