MEDICARE: ANDREA REGO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	50998	CA

General Provider Information

NPI Number	:	1790068013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA REGO

Provider Business Mailing Address
First Line	:	5607 BENHENRY CT
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95677-4503
Country	:	US
Telephone Number	:	916-315-3379
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 DOUGLAS BLVD
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-5901
Country	:	US
Telephone Number	:	916-791-7576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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