Healthcare Provider Details

I. General information

NPI: 1972681146
Provider Name (Legal Business Name): CONSTANCE REYNOLDS LANDIS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HELTON DR
FLORENCE AL
35630-1432
US

IV. Provider business mailing address

331 KINGSTON DR
FLORENCE AL
35633-1728
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-4474
  • Fax:
Mailing address:
  • Phone: 256-766-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10844
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: