Healthcare Provider Details

I. General information

NPI: 1659360170
Provider Name (Legal Business Name): LARRY D REED RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 12/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 WECKERLY RD
WHITEHOUSE OH
43571-9648
US

IV. Provider business mailing address

5911 WECKERLY RD
WHITEHOUSE OH
43571-9648
US

V. Phone/Fax

Practice location:
  • Phone: 567-246-8001
  • Fax: 419-913-3384
Mailing address:
  • Phone: 567-246-8001
  • Fax: 419-913-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-09243
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: