Provider Demographics
NPI:1508198722
Name:REBER, DALE A (R PH)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:REBER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1156
Mailing Address - Country:US
Mailing Address - Phone:719-545-0707
Mailing Address - Fax:719-546-3972
Practice Address - Street 1:3415 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1156
Practice Address - Country:US
Practice Address - Phone:719-545-0707
Practice Address - Fax:719-546-3972
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13121183500000X
AZS007578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist