Provider Demographics
NPI:1376133868
Name:REGNERY, JOEL WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:WILLIAM
Last Name:REGNERY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-3310
Mailing Address - Country:US
Mailing Address - Phone:618-466-1211
Mailing Address - Fax:
Practice Address - Street 1:2701 GODFREY RD
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-3310
Practice Address - Country:US
Practice Address - Phone:618-466-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051285884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist