Provider Demographics
NPI:1538279781
Name:REAVES, AMY M
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:REAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-6523
Mailing Address - Country:US
Mailing Address - Phone:334-214-9129
Mailing Address - Fax:334-214-9640
Practice Address - Street 1:3952 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-6523
Practice Address - Country:US
Practice Address - Phone:334-214-9129
Practice Address - Fax:334-214-9640
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist