Provider Demographics
NPI:1114223948
Name:REEDS PHARMACY LLC
Entity Type:Organization
Organization Name:REEDS PHARMACY LLC
Other - Org Name:REED'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-687-6081
Mailing Address - Street 1:675 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-1426
Mailing Address - Country:US
Mailing Address - Phone:937-687-6081
Mailing Address - Fax:937-687-6093
Practice Address - Street 1:675 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9173
Practice Address - Country:US
Practice Address - Phone:937-687-6081
Practice Address - Fax:937-687-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP022095550033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128657OtherPK
OH3133442Medicaid
2128657OtherPK