Healthcare Provider Details

I. General information

NPI: 1003927658
Provider Name (Legal Business Name): PETER ANTHONY REILLY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST PHARMACY SECTION
DETROIT MI
48201-1916
US

IV. Provider business mailing address

2870 PEBBLE CREEK DR
ANN ARBOR MI
48108-1728
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-4635
  • Fax: 313-576-1194
Mailing address:
  • Phone: 734-971-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number5302019994
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: