Provider Demographics
NPI:1225626583
Name:REID, JOHN ERNEST (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERNEST
Last Name:REID
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 1:4265 BERWICK PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5119
Mailing Address - Country:US
Mailing Address - Phone:703-763-9691
Mailing Address - Fax:
Practice Address - Street 1:36115 GOODWIN DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2029
Practice Address - Country:US
Practice Address - Phone:540-072-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202-0005328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist