Provider Demographics
NPI:1235410713
Name:REGAN, ALICE WHITSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:WHITSON
Last Name:REGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8425
Mailing Address - Country:US
Mailing Address - Phone:904-826-4180
Mailing Address - Fax:904-280-9852
Practice Address - Street 1:860 A1A N
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-3212
Practice Address - Country:US
Practice Address - Phone:904-543-0762
Practice Address - Fax:904-280-9852
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32432183500000X
SC10533183500000X
LA14283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist