MEDICARE: MR. GEORGE REESE II R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10955	AL

General Provider Information

NPI Number	:	1245374164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE REESE II R.PH.

Provider Business Mailing Address
First Line	:	218 LAKE FOREST WAY
Second Line	:
City	:	MAYLENE
State	:	AL
Zip	:	35114-4917
Country	:	US
Telephone Number	:	205-620-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1352 E HIGHLAND AVE
Second Line	:
City	:	SELMA
State	:	AL
Zip	:	36703-3210
Country	:	US
Telephone Number	:	334-872-9501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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