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General NPI Number Information
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NPI Number | 1922013564
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Entity Type | Organization
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Legal Business Name | REYNOLDS PHARMACY INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 162 W MAIN ST STE K
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City | WHITEWATER
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State | WI
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Zip | 53190-1995
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Country | US
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Telephone | 262-473-3444
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Fax | 262-473-3444
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Provider Business Mailing Address
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Address Line | 162 W MAIN ST STE K
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City | WHITEWATER
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State | WI
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Zip | 53190-1995
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Country | US
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Telephone | 262-473-3444
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Fax | 262-473-3444
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DAN REYNOLDS
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Credential |
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Telephone | 262-473-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 9277-42
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License Number State | WI
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