Provider Demographics
NPI:1043504996
Name:REICHARDT, CARINA LEE (RPH)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:LEE
Last Name:REICHARDT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N RANDALL RD
Mailing Address - Street 2:T-0839
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-9209
Mailing Address - Country:US
Mailing Address - Phone:630-406-5904
Mailing Address - Fax:630-406-5904
Practice Address - Street 1:115 N RANDALL RD
Practice Address - Street 2:T-0839
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-9209
Practice Address - Country:US
Practice Address - Phone:630-406-5904
Practice Address - Fax:630-406-5904
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.037425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist