Provider Demographics
NPI:1437498334
Name:REID, MITCHELL L (RPH)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:REID
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 1:3106 LOCUST HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6037
Mailing Address - Country:US
Mailing Address - Phone:864-414-2619
Mailing Address - Fax:
Practice Address - Street 1:3106 LOCUST HILL RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-6037
Practice Address - Country:US
Practice Address - Phone:864-414-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist