Provider Demographics
NPI:1962810481
Name:REID, JENNIFER CLAIRE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLAIRE
Last Name:REID
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 1:6134 WHITE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-3837
Mailing Address - Country:US
Mailing Address - Phone:864-295-3186
Mailing Address - Fax:
Practice Address - Street 1:6134 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3837
Practice Address - Country:US
Practice Address - Phone:864-295-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist