Provider Demographics
NPI:1083288021
Name:REA, JOHN OLDFORD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OLDFORD
Last Name:REA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MEDICAL CENTER RD STE F
Mailing Address - Street 2:
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-2612
Mailing Address - Country:US
Mailing Address - Phone:724-445-2727
Mailing Address - Fax:724-445-2627
Practice Address - Street 1:164 MEDICAL CENTER RD STE F
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-2612
Practice Address - Country:US
Practice Address - Phone:724-445-2727
Practice Address - Fax:724-445-2627
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040246L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist