MEDICARE: VICTOR REYNEKE

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	41310	TX

General Provider Information

NPI Number	:	1609257856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR REYNEKE

Provider Business Mailing Address
First Line	:	6220 HIGHWAY 287
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-2800
Country	:	US
Telephone Number	:	817-478-1313
Fax Number	:	817-478-0227

Provider Business Practice Location Address
First Line	:	6220 HIGHWAY 287
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-2800
Country	:	US
Telephone Number	:	817-478-1313
Fax Number	:	817-478-0227

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

Provider Enumeration Date	:	06/13/2015
Last Update Date	:	06/13/2015

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Directions to “ VICTOR REYNEKE ” Practice Location

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