Provider Demographics
NPI:1992536262
Name:CJ REYNOLDS PHARMACY GROUP LLC
Entity type:Organization
Organization Name:CJ REYNOLDS PHARMACY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-489-1076
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-0729
Mailing Address - Country:US
Mailing Address - Phone:252-489-1076
Mailing Address - Fax:877-965-1239
Practice Address - Street 1:200 E PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-4258
Practice Address - Country:US
Practice Address - Phone:318-326-4759
Practice Address - Fax:318-326-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy