Provider Demographics
NPI:1760757124
Name:MAGNUSSEN, REGINA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIE
Last Name:MAGNUSSEN
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 1:1030 BLAIRS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1220
Mailing Address - Country:US
Mailing Address - Phone:319-393-4348
Mailing Address - Fax:319-393-4348
Practice Address - Street 1:1030 BLAIRS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1220
Practice Address - Country:US
Practice Address - Phone:319-393-4348
Practice Address - Fax:319-393-4348
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist