Provider Demographics
NPI:1073887006
Name:REYNOLDS, TONY RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:RAY
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1704 W STOCKTON ST
Mailing Address - Street 2:EDMONTON
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-8137
Mailing Address - Country:US
Mailing Address - Phone:270-432-3111
Mailing Address - Fax:270-432-4111
Practice Address - Street 1:1704 WEST STOCKTON STREET.
Practice Address - Street 2:EDMONTON
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-3111
Practice Address - Fax:270-432-4111
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist