Provider Demographics
NPI:1417202292
Name:REESE, CORY THOMAS (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:THOMAS
Last Name:REESE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SOLDANO BLVD
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1422
Mailing Address - Country:US
Mailing Address - Phone:614-279-5678
Mailing Address - Fax:
Practice Address - Street 1:3720 SOLDANO BLVD
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1422
Practice Address - Country:US
Practice Address - Phone:614-279-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03132123-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist