Provider Demographics
NPI:1366837296
Name:REYNOLDS, JEWELL (RPH)
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:
Last Name:REYNOLDS
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 1:6376 S GLENCOE CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3535
Mailing Address - Country:US
Mailing Address - Phone:720-289-8756
Mailing Address - Fax:
Practice Address - Street 1:6376 S GLENCOE CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-3535
Practice Address - Country:US
Practice Address - Phone:720-289-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014158183500000X
CA32035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist