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General NPI Number Information
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NPI Number | 1881161610
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Entity Type | Individual
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Provider Name | LARRY ROBERT REIS RPH
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Gender | Male
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 551 WRANGLER ST
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City | OAKDALE
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State | CA
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Zip | 95361-8252
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Country | US
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Telephone | 559-301-2020
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Fax | 559-272-2124
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Provider Business Mailing Address
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Address Line | 551 WRANGLER ST
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City | OAKDALE
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State | CA
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Zip | 95361-8252
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Country | US
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Telephone | 559-301-2020
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Fax | 559-272-2124
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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 | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 27114
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License Number State | CA
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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 | 27114
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License Number State | CA
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