Provider Demographics
NPI:1760663355
Name:REYES, LERIE C (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:LERIE
Middle Name:C
Last Name:REYES
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1434
Mailing Address - Country:US
Mailing Address - Phone:917-534-1370
Mailing Address - Fax:
Practice Address - Street 1:144 BLEECKER STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:917-534-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760663355Medicaid