Healthcare Provider Details

I. General information

NPI: 1396827044
Provider Name (Legal Business Name): REBECCA ELLEN REYES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ELLEN GARNER/WHITAKER

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 05/29/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O MANIIAG HEALTH CENTER - PHARMACY DEPT. 436 5TH AVE
KOTZEBUE AK
99752
US

IV. Provider business mailing address

C/O MANIIAG HEALTH CENTER - PHARMACY DEPT. 436 5TH AVE
KOTZEBUE AK
99752
US

V. Phone/Fax

Practice location:
  • Phone: 602-573-2254
  • Fax: 602-263-1621
Mailing address:
  • Phone: 602-573-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberS12266
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: