Healthcare Provider Details

I. General information

NPI: 1386875482
Provider Name (Legal Business Name): EARLE JOHN REOME BSPHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 02/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-34 MITCHELL AVENUE
BINGHAMTON NY
13903
US

IV. Provider business mailing address

10-34 MITCHELL AVENUE
BINGHAMTON NY
13903
US

V. Phone/Fax

Practice location:
  • Phone: 607-762-2238
  • Fax: 607-762-3348
Mailing address:
  • Phone: 607-762-2238
  • Fax: 607-762-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048929
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number048929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: