Provider Demographics
NPI:1710621503
Name:REYNOSO, JOSE TRINIDAD (RPH)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:TRINIDAD
Last Name:REYNOSO
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 1:1525 OPAL DR UNIT F100
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3446
Mailing Address - Country:US
Mailing Address - Phone:775-401-1789
Mailing Address - Fax:
Practice Address - Street 1:1740 MOUNTAIN CITY HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2411
Practice Address - Country:US
Practice Address - Phone:775-777-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV204361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist