Healthcare Provider Details

I. General information

NPI: 1598357246
Provider Name (Legal Business Name): LESLIE CLAIRE REYNOLDS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 JOHNSON DR
DANIELSVILLE GA
30633-7051
US

IV. Provider business mailing address

PO BOX 127
DANIELSVILLE GA
30633-0127
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-0920
  • Fax: 706-795-3025
Mailing address:
  • Phone: 706-795-0920
  • Fax: 706-795-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: