Provider Demographics
NPI:1205381894
Name:REYES, RICARDO JOSE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JOSE
Last Name:REYES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:RICKY
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1325 57TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6581
Mailing Address - Country:US
Mailing Address - Phone:701-415-7013
Mailing Address - Fax:701-415-7004
Practice Address - Street 1:1325 57TH AVE NE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6581
Practice Address - Country:US
Practice Address - Phone:701-415-7013
Practice Address - Fax:701-415-7004
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299021183500000X
KY018169183500000X
NDRPH6203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist