Provider Demographics
NPI:1194883173
Name:REYNOLDS, ANN (RPH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EASY ST
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9750
Mailing Address - Country:US
Mailing Address - Phone:970-779-3102
Mailing Address - Fax:
Practice Address - Street 1:871 COUNTY ROAD 501
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9462
Practice Address - Country:US
Practice Address - Phone:970-884-9133
Practice Address - Fax:970-884-0723
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist