Provider Demographics
NPI:1326574765
Name:REID, CONTRELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CONTRELLE
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LOCHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5978
Mailing Address - Country:US
Mailing Address - Phone:803-551-2609
Mailing Address - Fax:844-719-0109
Practice Address - Street 1:112 LOCHAVEN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5978
Practice Address - Country:US
Practice Address - Phone:803-551-2609
Practice Address - Fax:844-719-0109
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24012183500000X
SC11428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist