Provider Demographics
NPI:1407145816
Name:HARRELL, REGINA B (RPH)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:B
Last Name:HARRELL
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 1:38 OCMULGEE DR
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6652
Mailing Address - Country:US
Mailing Address - Phone:478-783-2982
Mailing Address - Fax:478-783-3271
Practice Address - Street 1:#8 SURREY PLAZA
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036
Practice Address - Country:US
Practice Address - Phone:478-783-3286
Practice Address - Fax:478-783-3271
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018888183500000X
MI5302024824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist