Provider Demographics
NPI:1356648323
Name:REYNOLDS, EDWARD HAMMOND JR (BS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:HAMMOND
Last Name:REYNOLDS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1458
Mailing Address - Country:US
Mailing Address - Phone:864-877-2359
Mailing Address - Fax:864-877-2359
Practice Address - Street 1:1232 W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1243
Practice Address - Country:US
Practice Address - Phone:864-801-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist