Provider Demographics
NPI:1407879927
Name:REED, JARVIS MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JARVIS
Middle Name:MARK
Last Name:REED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3220
Mailing Address - Country:US
Mailing Address - Phone:304-788-1643
Mailing Address - Fax:304-788-0525
Practice Address - Street 1:43 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3220
Practice Address - Country:US
Practice Address - Phone:304-788-1643
Practice Address - Fax:304-788-0525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0139139000Medicaid
MD47991270Medicaid
WV0139139000Medicaid