Provider Demographics
NPI:1225478076
Name:MOORE, REGINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4701 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8807
Mailing Address - Country:US
Mailing Address - Phone:541-902-7333
Mailing Address - Fax:541-902-7327
Practice Address - Street 1:4701 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8807
Practice Address - Country:US
Practice Address - Phone:541-902-7333
Practice Address - Fax:541-902-7327
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13116183500000X, 1835P0018X
NV17865183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist