Healthcare Provider Details

I. General information

NPI: 1932969656
Provider Name (Legal Business Name): KATRINA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

8390 WILDCAT RD
TIPP CITY OH
45371-9141
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number03233678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: