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NPI Code Detail

MEDICARE: MICHELLE REAGON PHARMD

MEDICARE: MICHELLE REAGON PHARMD
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
1183500000XPharmacist051292592IL

General Provider Information

NPI Number : 1982987574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE REAGON PHARMD
Provider Business Mailing Address
First Line : 2945 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-4024
Country : US
Telephone Number : 217-788-5846
Fax Number : 217-788-8128
Provider Business Practice Location Address
First Line : 2945 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-4024
Country : US
Telephone Number : 217-788-5846
Fax Number : 217-788-8128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 09/21/2011

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Directions to “ MICHELLE REAGON PHARMD” Practice Location

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