Provider Demographics
NPI:1447849922
Name:OBREGON, KEVIN (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:OBREGON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SPLITLEAF CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9656
Mailing Address - Country:US
Mailing Address - Phone:360-633-6817
Mailing Address - Fax:
Practice Address - Street 1:1011 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1539
Practice Address - Country:US
Practice Address - Phone:229-273-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist