Provider Demographics
NPI:1386875482
Name:REOME, EARLE JOHN (BSPHARM)
Entity type:Individual
Prefix:MR
First Name:EARLE
Middle Name:JOHN
Last Name:REOME
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10-34 MITCHELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-762-2238
Mailing Address - Fax:607-762-3348
Practice Address - Street 1:10-34 MITCHELL AVENUE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-762-2238
Practice Address - Fax:607-762-3348
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048929183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY 048929OtherNY STATE LICENSE
CTPT 9528OtherCT STATE LICENSE