Provider Demographics
NPI:1588265805
Name:DAVIS, REGINA DALE (PD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:DALE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 WARRIER CHIEF TRL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8765
Mailing Address - Country:US
Mailing Address - Phone:501-622-0268
Mailing Address - Fax:
Practice Address - Street 1:4019 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-7689
Practice Address - Fax:501-624-3314
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist