Provider Demographics
NPI:1700100492
Name:FELIZARDO, REGINA LYNNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LYNNE
Last Name:FELIZARDO
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 1:9505 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2801
Mailing Address - Country:US
Mailing Address - Phone:253-582-2230
Mailing Address - Fax:253-582-0654
Practice Address - Street 1:9505 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98499-2801
Practice Address - Country:US
Practice Address - Phone:253-582-2230
Practice Address - Fax:253-582-0654
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist