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General NPI Number Information
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NPI Number | 1619036415
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Entity Type | Individual
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Provider Name | EDWARD F REYNOLDS III R.PH.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-646-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 381 HARTFORD RD
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City | MANCHESTER
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State | CT
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Zip | 06040-5727
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Country | US
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Telephone | 860-227-8976
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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 | 9801
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26605
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 04786
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5991
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License Number State | ME
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