Provider Demographics
NPI:1982987947
Name:REID, RON (RPH)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2294
Mailing Address - Country:US
Mailing Address - Phone:801-653-2709
Mailing Address - Fax:801-653-2706
Practice Address - Street 1:198 N 1200 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2294
Practice Address - Country:US
Practice Address - Phone:801-653-2709
Practice Address - Fax:801-653-2706
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322704-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist