Provider Demographics
NPI:1114123197
Name:ETIENNE, REGINA ANN STANEK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ANN STANEK
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 CHERRY PLUM DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2827
Mailing Address - Country:US
Mailing Address - Phone:719-205-4512
Mailing Address - Fax:
Practice Address - Street 1:3685 CHERRY PLUM DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2827
Practice Address - Country:US
Practice Address - Phone:719-205-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist