Provider Demographics
NPI:1730782517
Name:ROGERS, BETH MYRICK (RPH)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MYRICK
Last Name:ROGERS
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 1:1030 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1343
Mailing Address - Country:US
Mailing Address - Phone:706-202-8745
Mailing Address - Fax:
Practice Address - Street 1:196 ALPS RD STE 20B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4096
Practice Address - Country:US
Practice Address - Phone:706-369-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist