Provider Demographics
NPI:1669342903
Name:REISETTER, BRIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:REISETTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COUNTY ROAD 205
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9794
Mailing Address - Country:US
Mailing Address - Phone:662-636-6077
Mailing Address - Fax:
Practice Address - Street 1:27 COUNTY ROAD 205
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9794
Practice Address - Country:US
Practice Address - Phone:662-636-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-010314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty