Provider Demographics
NPI:1295011682
Name:HRUSH, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:HRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2968
Mailing Address - Country:US
Mailing Address - Phone:919-870-1348
Mailing Address - Fax:919-846-0456
Practice Address - Street 1:8701 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2968
Practice Address - Country:US
Practice Address - Phone:919-870-1348
Practice Address - Fax:919-846-0456
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist