Provider Demographics
NPI:1407210727
Name:WILSON-HANNA, REGINA MARSHALL (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARSHALL
Last Name:WILSON-HANNA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 NW 205TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2373
Mailing Address - Country:US
Mailing Address - Phone:786-201-1467
Mailing Address - Fax:
Practice Address - Street 1:1641 WORTHINGTON RD STE 120
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6706
Practice Address - Country:US
Practice Address - Phone:561-615-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist