Provider Demographics
NPI:1386931145
Name:REYNOLDS, SUANNE (RPH)
Entity type:Individual
Prefix:
First Name:SUANNE
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 1:9601 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7949
Mailing Address - Country:US
Mailing Address - Phone:425-397-8944
Mailing Address - Fax:425-397-8944
Practice Address - Street 1:9601 MARKET PL
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7949
Practice Address - Country:US
Practice Address - Phone:425-397-8944
Practice Address - Fax:425-397-8944
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00019027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist