Reidland Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P06520 Issued in KY

Legal business name

REIDLAND PHARMACY INC

Practice address

5433 Reidland Rd
Paducah, KY 42003-0954

Phone

(270) 898-7313

Fax

(270) 898-1999

NPI assigned

Aug 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marshall Davis, RPHNPI 1659972628

Title

President

Phone

(270) 443-1442

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• REIDLAND PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marshall W Davis, RPH

  • Pharmacist
  • Paducah, KY
  • NPI 1659972628
  NPD (past) Authorized official
• Tracy Michelle Sullivan, RPH

  • Pharmacist
  • Paducah, KY
  • NPI 1558962548
  NPD
• Brianna Katherine Sullivan, PHARM D

  • Pharmacist
  • Paducah, KY
  • NPI 1871194878
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1174539746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5433 REIDLAND RD",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420030954",
            "telephone_number": "270-898-7313",
            "fax_number": "270-898-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5433 REIDLAND RD",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420030954",
            "telephone_number": "270-898-7313",
            "fax_number": "270-898-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REIDLAND PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-443-1442",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P06520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54000153",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90000308",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1802277",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REIDLAND PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Reeves, PTA
• Shea Reeves
• Reforged
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• Catherine Lee Reimnitz, APRN, FNP-C,PMHNP-BC
• Jamie K Reinold, IHP, CPT
• Lisa Reiss
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• Community/Retail Pharmacy in Paducah, KY
• Providers in Paducah, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.