Healthcare Provider Details

I. General information

NPI: 1881748655
Provider Name (Legal Business Name): MR. BRANDON EUGENE REID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 BACHMAN RD
SARDINIA OH
45171-9456
US

IV. Provider business mailing address

144 BIG PINE RD
WINCHESTER OH
45697-9003
US

V. Phone/Fax

Practice location:
  • Phone: 800-284-8741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-25415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: