Provider Demographics
NPI:1235136482
Name:REED, TALLY R (RPH)
Entity Type:Individual
Prefix:
First Name:TALLY
Middle Name:R
Last Name:REED
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4253 MARTINSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-5059
Mailing Address - Country:US
Mailing Address - Phone:304-258-1929
Mailing Address - Fax:304-258-2670
Practice Address - Street 1:261 BERKMORE PL
Practice Address - Street 2:SUITE 1C
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-6247
Practice Address - Country:US
Practice Address - Phone:304-258-3800
Practice Address - Fax:304-258-2670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00005390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist