Basic Information
| Provider Information | |||||||||
| NPI: | 1053649442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | TIYAJI | ||||||||
| MiddleName: | KIKIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1831 PARKVIEW LN | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774594517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135207777 | ||||||||
| FaxNumber: | 7125206049 | ||||||||
| Practice Location | |||||||||
| Address1: | 3317 MONTROSE BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770063931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135207777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 39459 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.