Provider Demographics
NPI:1386798106
Name:DANNREUTHER, JAMES CHRIS (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHRIS
Last Name:DANNREUTHER
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 1:122 VALENTINE DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4936
Mailing Address - Country:US
Mailing Address - Phone:228-868-2031
Mailing Address - Fax:
Practice Address - Street 1:12372 HWY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-832-1414
Practice Address - Fax:228-832-1479
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE05383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist