Provider Demographics
NPI:1679173231
Name:REAGIN, JOHN GREGORY (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:REAGIN
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 1:2204 DUBLIN EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:GA
Mailing Address - Zip Code:31019-3934
Mailing Address - Country:US
Mailing Address - Phone:478-290-8096
Mailing Address - Fax:478-374-3433
Practice Address - Street 1:1099 INDIAN DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-7663
Practice Address - Country:US
Practice Address - Phone:478-374-3403
Practice Address - Fax:478-374-3433
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist