Provider Demographics
NPI:1285919324
Name:REGO, JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:REGO
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 1:159 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1046
Mailing Address - Country:US
Mailing Address - Phone:205-823-9250
Mailing Address - Fax:
Practice Address - Street 1:1551 FORESTDALE BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-3017
Practice Address - Country:US
Practice Address - Phone:205-798-8360
Practice Address - Fax:205-798-6130
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist