Provider Demographics
NPI:1609464387
Name:REEVES, JESSE EUGENE III (RPH)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:EUGENE
Last Name:REEVES
Suffix:III
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 1:1982 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3422
Mailing Address - Country:US
Mailing Address - Phone:318-263-2919
Mailing Address - Fax:318-263-9819
Practice Address - Street 1:1982 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3422
Practice Address - Country:US
Practice Address - Phone:318-263-2919
Practice Address - Fax:318-263-9819
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.010221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.010221OtherLOUISIANA BOARD OF PHARMACY