=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437830155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGAN DEAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2023
-----------------------------------------------------
Last Update Date | 09/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91-1051 FRANKLIN D ROOSEVELT AVE
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-2185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-214-1306
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91-3598 NANA HOPE ST UNIT 509
-----------------------------------------------------
City | EWA BEACH
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96706-6825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-931-8785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 023662
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------