=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326144924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARRY REED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5911 WECKERLY RD
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43571-9648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-877-5712
-----------------------------------------------------
Fax | 419-877-0222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5911 WECKERLY RD
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43571-9648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-877-5712
-----------------------------------------------------
Fax | 419-877-0222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. LARRY D REED
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 419-877-5712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 02-0373800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------