=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225688377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REID L SINDELAR PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2019
-----------------------------------------------------
Last Update Date | 09/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 241 ELM ST STE 5
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03743-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-543-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 105
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05037-0105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-727-6504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | R2151
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------