Healthcare Provider Details

I. General information

NPI: 1487284139
Provider Name (Legal Business Name): ALEXANDRIA MARY REID PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 US HIGHWAY 23 S
ALPENA MI
49707-4542
US

IV. Provider business mailing address

330 RIDGE ST
SAULT SAINTE MARIE MI
49783-1844
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-4630
  • Fax:
Mailing address:
  • Phone: 313-670-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: