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General NPI Number Information
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NPI Number | 1306440755
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Entity Type | Individual
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Provider Name | MR. RANDY REITZ
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Gender | Male
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 9805 GEIST CROSSING DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4819
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Country | US
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Telephone | 317-577-1353
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Fax | 317-577-0529
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Provider Business Mailing Address
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Address Line | 11241 TUFTON ST
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City | FISHERS
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State | IN
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Zip | 46038-2265
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Country | US
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Telephone | 317-409-4158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 26017004A
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License Number State | IN
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