Provider Demographics
NPI:1316481666
Name:REIS, RICHARD (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:REIS
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 1:2209 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2730
Mailing Address - Country:US
Mailing Address - Phone:559-246-1097
Mailing Address - Fax:559-897-4905
Practice Address - Street 1:2209 HOWARD ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2730
Practice Address - Country:US
Practice Address - Phone:559-246-1097
Practice Address - Fax:559-897-4905
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47872OtherPHARMACIST LICENSE