Provider Demographics
NPI:1548062433
Name:BOCANEGRA, REYNA KAE (PHARMD)
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:KAE
Last Name:BOCANEGRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8238 ROANOKE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2727
Mailing Address - Country:US
Mailing Address - Phone:410-841-9768
Mailing Address - Fax:
Practice Address - Street 1:165 ORVILLE RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-1309
Practice Address - Country:US
Practice Address - Phone:410-238-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist