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General NPI Number Information
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NPI Number | 1477898641
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Entity Type | Individual
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Provider Name | TODD MARVIN REAGAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 5005 N PIEDRAS ST
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City | EL PASO
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State | TX
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Zip | 79920-5001
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Country | US
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Telephone | 865-292-5957
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Fax |
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Provider Business Mailing Address
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Address Line | 5137 WILD CHERRY LN
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City | STRAWBERRY PLAINS
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State | TN
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Zip | 37871-3744
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Country | US
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Telephone | 865-292-5957
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33342
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License Number State | TN
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