Active NPI
Theodore Shawn Regalia, R.PH.
- Pharmacist
- Fall Creek, WI
National Provider Identifier
1083809982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10973-040
- Practice address
- 6725 Otter Creek Rd
Fall Creek, WI 54742-9378 - Phone
- (715) 563-1586
- Fax
- (715) 855-5062
- NPI assigned
- Sep 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10973-040 | WI | Primary |
Addresses
Primary practice location
6725 Otter Creek Rd
Fall Creek, WI 54742-9378
Mailing address
6725 Otter Creek Rd
Fall Creek, WI 54742-9378
Phone (715) 563-1586
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10973-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356566400000",
"number": "1083809982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6725 OTTER CREEK RD",
"city": "FALL CREEK",
"state": "WI",
"postal_code": "547429378",
"telephone_number": "715-563-1586",
"fax_number": "715-855-5062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6725 OTTER CREEK RD",
"city": "FALL CREEK",
"state": "WI",
"postal_code": "547429378",
"telephone_number": "715-563-1586",
"fax_number": "715-855-5062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGALIA",
"first_name": "THEODORE",
"middle_name": "SHAWN",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-13",
"last_updated": "2012-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10973-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fall Creek, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.