Provider Demographics
NPI:1992979298
Name:BLEVINS, REGINA K (PHARM-D, RPH)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:K
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PHARM-D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 H STREET E
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:406-768-3299
Practice Address - Street 1:107 H STREET E
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:406-768-3299
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5926OtherPHARMACIST