Provider Demographics
NPI:1194596940
Name:REILLY, JOHN (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REILLY
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 1:4623 WESLEY AVE STE N
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2272
Mailing Address - Country:US
Mailing Address - Phone:513-236-4102
Mailing Address - Fax:833-347-5635
Practice Address - Street 1:4623 WESLEY AVE STE N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2272
Practice Address - Country:US
Practice Address - Phone:513-246-5675
Practice Address - Fax:833-347-5635
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist