Provider Demographics
NPI:1548369325
Name:REIS, AUDREY ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ANN
Last Name:REIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMOOR
Mailing Address - State:SC
Mailing Address - Zip Code:29712-5709
Mailing Address - Country:US
Mailing Address - Phone:803-789-7313
Mailing Address - Fax:704-355-6903
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5874
Practice Address - Country:US
Practice Address - Phone:704-355-6901
Practice Address - Fax:704-355-6903
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17590183500000X
SC011126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist