Provider Demographics
NPI:1023619095
Name:EALY, ROGER D SR
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:EALY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-4352
Mailing Address - Country:US
Mailing Address - Phone:603-332-8438
Mailing Address - Fax:603-332-8438
Practice Address - Street 1:116 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-4352
Practice Address - Country:US
Practice Address - Phone:603-332-8438
Practice Address - Fax:603-332-8438
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist