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General NPI Number Information
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NPI Number | 1669763108
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Entity Type | Individual
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Provider Name | GARY L. REYNOLDS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2011
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Last Update Date | 05/01/2011
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Provider Practice Location Address
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Address Line | 1055 E MAIN ST
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City | PULASKI
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State | VA
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Zip | 24301-5217
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Country | US
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Telephone | 540-994-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 E MAIN ST
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City | PULASKI
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State | VA
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Zip | 24301-5217
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Country | US
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Telephone | 540-994-9390
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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 | 0202009306
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License Number State | VA
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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 | RP0007433
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License Number State | WV
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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 | PH.13239
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License Number State | SC
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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 | 026724-1
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License Number State | NY
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