MEDICARE: MR. JOHN M REICHERT RPH, MPA

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	26014123A	IN

General Provider Information

NPI Number	:	1609852466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN M REICHERT RPH, MPA

Provider Business Mailing Address
First Line	:	101 1/2 S MAIN ST
Second Line	:
City	:	BOURBON
State	:	IN
Zip	:	46504-1649
Country	:	US
Telephone Number	:	574-342-5605
Fax Number	:	574-342-5605

Provider Business Practice Location Address
First Line	:	101 1/2 S MAIN ST
Second Line	:
City	:	BOURBON
State	:	IN
Zip	:	46504-1649
Country	:	US
Telephone Number	:	574-342-5605
Fax Number	:	574-342-5605

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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