Provider Demographics
NPI:1710276076
Name:REISZ, JUANITA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:REISZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 PINE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4500
Mailing Address - Country:US
Mailing Address - Phone:270-683-7314
Mailing Address - Fax:
Practice Address - Street 1:1921 W PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3542
Practice Address - Country:US
Practice Address - Phone:270-683-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8979183500000X
AL6933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist