Provider Demographics
NPI:1760679153
Name:ROGERS, KENNETH PAUL (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:ROGERS
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 1:1164 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3906
Mailing Address - Country:US
Mailing Address - Phone:864-233-7940
Mailing Address - Fax:864-233-4615
Practice Address - Street 1:1164 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3906
Practice Address - Country:US
Practice Address - Phone:864-233-7940
Practice Address - Fax:864-233-4615
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist