Healthcare Provider Details

I. General information

NPI: 1457710113
Provider Name (Legal Business Name): ERIC REIGEL PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WHITEHALL DR SUITE 109
SAINT AUGUSTINE FL
32086-5269
US

IV. Provider business mailing address

105 WHITEHALL DR SUITE 109
SAINT AUGUSTINE FL
32086-5269
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2782
  • Fax:
Mailing address:
  • Phone: 904-829-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS35101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: