Provider Demographics
NPI:1619262581
Name:REEDER, CARL JOE (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JOE
Last Name:REEDER
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 1:4001 MCEWEN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5020
Mailing Address - Country:US
Mailing Address - Phone:817-343-3633
Mailing Address - Fax:214-296-0243
Practice Address - Street 1:4001 MCEWEN RD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5020
Practice Address - Country:US
Practice Address - Phone:817-343-3633
Practice Address - Fax:214-296-0243
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist