Provider Demographics
NPI:1609852466
Name:REICHERT, JOHN M (RPH, MPA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:REICHERT
Suffix:
Gender:M
Credentials:RPH, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 1/2 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOURBON
Mailing Address - State:IN
Mailing Address - Zip Code:46504-1649
Mailing Address - Country:US
Mailing Address - Phone:574-342-5605
Mailing Address - Fax:574-342-5605
Practice Address - Street 1:101 1/2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1649
Practice Address - Country:US
Practice Address - Phone:574-342-5605
Practice Address - Fax:574-342-5605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014123A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist