Active NPI
Philip G Reynolds Jr.
- Pharmacist
- Rogers, AR
National Provider Identifier
1053914572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13558
- Practice address
- 1211 S 55TH St
Rogers, AR 72758-8437 - Phone
- (479) 899-4409
- NPI assigned
- Nov 18, 2020
- Last updated
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13558 | LA | Primary |
Addresses
Primary practice location
1211 S 55TH St
Rogers, AR 72758-8437
Mailing address
1211 S 55TH St
Rogers, AR 72758-8437
Phone (479) 899-4409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13558 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1053914572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 S 55TH ST",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588437",
"telephone_number": "479-899-4409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 S 55TH ST",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588437",
"telephone_number": "479-899-4409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "PHILIP",
"middle_name": "G",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "13558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.