Provider Demographics
NPI:1154767648
Name:REINHARD, MARK S (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:REINHARD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2054
Mailing Address - Country:US
Mailing Address - Phone:804-640-2198
Mailing Address - Fax:304-769-5133
Practice Address - Street 1:762 LITTLE COAL RIVER RD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-9262
Practice Address - Country:US
Practice Address - Phone:304-756-2160
Practice Address - Fax:304-756-1262
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00074181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist