Provider Demographics
NPI:1609235209
Name:REYNA, GERALD (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:REYNA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4604
Mailing Address - Country:US
Mailing Address - Phone:915-584-1153
Mailing Address - Fax:
Practice Address - Street 1:5900 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4604
Practice Address - Country:US
Practice Address - Phone:915-584-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10654OtherPHARMACY LICENSE NUMBER