Provider Demographics
NPI:1053692749
Name:REGER, STACY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:D
Last Name:REGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2807
Mailing Address - Country:US
Mailing Address - Phone:716-639-8598
Mailing Address - Fax:
Practice Address - Street 1:5275 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-2807
Practice Address - Country:US
Practice Address - Phone:716-639-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist