Provider Demographics
NPI:1053680397
Name:REEDY, ROBERT III (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ROBERT
Middle Name:
Last Name:REEDY
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 WAYMAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-4068
Mailing Address - Country:US
Mailing Address - Phone:863-937-6692
Mailing Address - Fax:863-937-6696
Practice Address - Street 1:1704 WAYMAN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-4068
Practice Address - Country:US
Practice Address - Phone:863-937-6692
Practice Address - Fax:863-937-6696
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT19090183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician