Healthcare Provider Details

I. General information

NPI: 1780798728
Provider Name (Legal Business Name): JOHN ROBERT REID III D.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S ASH ST
NOWATA OK
74048-4627
US

IV. Provider business mailing address

206 S ASH ST
NOWATA OK
74048-4627
US

V. Phone/Fax

Practice location:
  • Phone: 918-273-0433
  • Fax: 918-273-0433
Mailing address:
  • Phone: 918-273-0433
  • Fax: 918-273-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8912
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: