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General NPI Number Information
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NPI Number | 1790060903
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Entity Type | Individual
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Provider Name | MR. BRIAN WILLIAM REUSCH
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 835 W GALENA AVE
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City | FREEPORT
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State | IL
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Zip | 61032-3973
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Country | US
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Telephone | 815-232-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 2857 LUND AVE APT 12
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City | ROCKFORD
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State | IL
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Zip | 61109-6031
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Country | US
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Telephone | 815-985-6914
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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 | 051.295385
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License Number State | IL
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