Provider Demographics
NPI:1255093191
Name:REEDY, JOHN WAYNE JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WAYNE
Last Name:REEDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 GREENSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-3904
Mailing Address - Country:US
Mailing Address - Phone:412-979-8085
Mailing Address - Fax:
Practice Address - Street 1:1901 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1607
Practice Address - Country:US
Practice Address - Phone:412-421-2903
Practice Address - Fax:412-421-2961
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist