Provider Demographics
NPI:1124003371
Name:REYNOLDS, JOHN MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:REYNOLDS
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 1:1557 MOUNT EATON RD S
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9770
Mailing Address - Country:US
Mailing Address - Phone:330-828-8891
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1638
Practice Address - Country:US
Practice Address - Phone:330-682-1956
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-10824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist