Healthcare Provider Details

I. General information

NPI: 1225749591
Provider Name (Legal Business Name): KAILEE REINACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E INDUSTRIAL PARK RD
MURPHYSBORO IL
62966-3947
US

IV. Provider business mailing address

550 E INDUSTRIAL PARK RD
MURPHYSBORO IL
62966-3947
US

V. Phone/Fax

Practice location:
  • Phone: 618-687-9454
  • Fax:
Mailing address:
  • Phone: 618-687-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023176
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: