=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487284139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRIA MARY REID PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2020
-----------------------------------------------------
Last Update Date | 01/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 US HIGHWAY 23 S
-----------------------------------------------------
City | ALPENA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49707-4542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-354-4630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 RIDGE ST
-----------------------------------------------------
City | SAULT SAINTE MARIE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49783-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-670-6533
-----------------------------------------------------
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 | 5302412089
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------