Provider Demographics
NPI:1063020667
Name:REID, ALYSSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-1720
Mailing Address - Country:US
Mailing Address - Phone:662-562-9366
Mailing Address - Fax:662-562-9353
Practice Address - Street 1:5148 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-1720
Practice Address - Country:US
Practice Address - Phone:662-562-9366
Practice Address - Fax:662-562-9353
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-16553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist