Tony Ray Reynolds, R.PH.
Individual provider Active NPI Pharmacist · Edmonton, KY
NPI 1073887006 · NPPES record last updated Mar 8, 2012
Key facts
- NPI
- 1073887006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 8654 (KY)
- Practice address
- 1704 West Stockton Street.
Edmonton
Edmonton, KY 42129-8137 - Phone
- (270) 432-3111
- Fax
- (270) 432-4111
- NPI assigned
- Mar 8, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8654 | KY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8654 | KY | Yes |
Addresses
Primary practice location
1704 West Stockton Street.
Edmonton
Edmonton, KY 42129-8137
Mailing address
1704 W Stockton St
Edmonton
Edmonton, KY 42129-8137
Phone (270) 432-3111
Other providers in Edmonton, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.