Provider Demographics
NPI:1578846705
Name:DOWNING, JACK REED (RPH)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:REED
Last Name:DOWNING
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 1:4825 SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7909
Mailing Address - Country:US
Mailing Address - Phone:270-393-2115
Mailing Address - Fax:270-393-7280
Practice Address - Street 1:4825 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7909
Practice Address - Country:US
Practice Address - Phone:270-393-2115
Practice Address - Fax:270-393-7280
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist