Provider Demographics
NPI:1477698769
Name:REED, PATRESE DANIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRESE
Middle Name:DANIELLE
Last Name:REED
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1419
Mailing Address - Country:US
Mailing Address - Phone:606-432-2866
Mailing Address - Fax:606-437-6517
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:SUITE 105
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-432-0018
Practice Address - Fax:606-437-6517
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54034939Medicaid
KY54034939Medicaid