Healthcare Provider Details

I. General information

NPI: 1689442139
Provider Name (Legal Business Name): ROBERT ANDREW REICHERT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N MAIN ST
ANNA IL
62906-1668
US

IV. Provider business mailing address

PO BOX 146
GRAND CHAIN IL
62941-0146
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4511
  • Fax:
Mailing address:
  • Phone: 618-713-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: