MEDICARE: DR. JESSE ARLEN REILLY PHARMD

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	0019908	CO

General Provider Information

NPI Number	:	1255767315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE ARLEN REILLY PHARMD

Provider Business Mailing Address
First Line	:	2977 ROCHE DR N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1735
Country	:	US
Telephone Number	:	719-243-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2977 ROCHE DR N
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1735
Country	:	US
Telephone Number	:	719-243-8798
Fax Number	:

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/03/2020

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