Provider Demographics
NPI:1114214194
Name:FRANKLIN, REGINA ANN (BS RPH)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANN
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:BS RPH
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS RPH
Mailing Address - Street 1:1500 EAST WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-9910
Mailing Address - Country:US
Mailing Address - Phone:601-364-1555
Mailing Address - Fax:601-364-1578
Practice Address - Street 1:1500 EAST WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-9910
Practice Address - Country:US
Practice Address - Phone:601-364-1555
Practice Address - Fax:601-364-1578
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-7192183500000X
NV12878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist