Provider Demographics
NPI:1558679969
Name:ALEXANDER, REGINA A (PHARM D)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:ALEXANDER
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 1:880 WILLIAM BLVD
Mailing Address - Street 2:#811
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1588
Mailing Address - Country:US
Mailing Address - Phone:985-713-1533
Mailing Address - Fax:
Practice Address - Street 1:540 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3600
Practice Address - Country:US
Practice Address - Phone:601-371-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE010592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist