Healthcare Provider Details

I. General information

NPI: 1467767533
Provider Name (Legal Business Name): JOHN M REARDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PERRY HWY
PITTSBURGH PA
15229-1820
US

IV. Provider business mailing address

513 PERRY HWY
PITTSBURGH PA
15229-1820
US

V. Phone/Fax

Practice location:
  • Phone: 412-931-7751
  • Fax: 412-931-5231
Mailing address:
  • Phone: 412-931-7751
  • Fax: 412-931-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036118L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: