Healthcare Provider Details

I. General information

NPI: 1053455360
Provider Name (Legal Business Name): HEATHER MCREE REYNOLDS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HANCOCK ST S
FORT GAINES GA
39851-4338
US

IV. Provider business mailing address

423 WOODLAWN DR
EUFAULA AL
36027-5024
US

V. Phone/Fax

Practice location:
  • Phone: 229-768-2422
  • Fax: 229-768-2449
Mailing address:
  • Phone: 334-688-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022488
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: