Provider Demographics
NPI:1073101721
Name:REYES, JOANNA GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRACE
Last Name:REYES
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 1:3379 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2412
Mailing Address - Country:US
Mailing Address - Phone:408-609-7380
Mailing Address - Fax:
Practice Address - Street 1:576 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1940
Practice Address - Country:US
Practice Address - Phone:408-739-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist