Healthcare Provider Details

I. General information

NPI: 1326144924
Provider Name (Legal Business Name): LARRY REED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/20/2008
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: 419-877-5712
  • Fax: 419-877-0222
Mailing address:
  • Phone: 419-877-5712
  • Fax: 419-877-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number02-0373800
License Number StateOH

VIII. Authorized Official

Name: MR. LARRY D REED
Title or Position: OWNER
Credential: RPH
Phone: 419-877-5712