Healthcare Provider Details

I. General information

NPI: 1851373732
Provider Name (Legal Business Name): ANTONIO F. REYES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N PIEDRAS ST WILLIAM BEAUMONT ARMY MEDICAL CENTER
EL PASO TX
79920-5001
US

IV. Provider business mailing address

5001 N PIEDRAS ST EL PASO VAHCS
EL PASO TX
79930-4210
US

V. Phone/Fax

Practice location:
  • Phone: 915-569-2170
  • Fax:
Mailing address:
  • Phone: 915-564-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03180
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: