Provider Demographics
NPI:1700417664
Name:REESE, ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1952
Mailing Address - Country:US
Mailing Address - Phone:248-414-5761
Mailing Address - Fax:248-414-5764
Practice Address - Street 1:539 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1952
Practice Address - Country:US
Practice Address - Phone:248-414-5761
Practice Address - Fax:248-414-5764
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist