=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225626583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ERNEST REID RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2021
-----------------------------------------------------
Last Update Date | 01/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36115 GOODWIN DR
-----------------------------------------------------
City | LOCUST GROVE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22508-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-072-0319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4265 BERWICK PL
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-5119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-763-9691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0202-0005328
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------