Healthcare Provider Details

I. General information

NPI: 1215089933
Provider Name (Legal Business Name): BOBBY WAYNE REEVES PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W ELM ST
HILLSBORO TX
76645-2036
US

IV. Provider business mailing address

636 HAMROCK RD
ITALY TX
76651-0636
US

V. Phone/Fax

Practice location:
  • Phone: 254-582-2561
  • Fax:
Mailing address:
  • Phone: 972-483-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17183
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: