Provider Demographics
NPI:1376758532
Name:JOHN RENO
Entity Type:Organization
Organization Name:JOHN RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACISTOWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:620-357-8305
Mailing Address - Street 1:519 MAIN ST
Mailing Address - Street 2:BOX 68
Mailing Address - City:JETMORE
Mailing Address - State:KS
Mailing Address - Zip Code:67854-0068
Mailing Address - Country:US
Mailing Address - Phone:620-357-8305
Mailing Address - Fax:620-357-8305
Practice Address - Street 1:519 MAIN ST
Practice Address - Street 2:BOX 68
Practice Address - City:JETMORE
Practice Address - State:KS
Practice Address - Zip Code:67854-0068
Practice Address - Country:US
Practice Address - Phone:620-357-8305
Practice Address - Fax:620-357-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100438040AMedicaid
5103030001Medicare NSC