Provider Demographics
NPI:1770852931
Name:REEVES, MARK D (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:REEVES
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5957
Mailing Address - Country:US
Mailing Address - Phone:217-446-1215
Mailing Address - Fax:
Practice Address - Street 1:842 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5957
Practice Address - Country:US
Practice Address - Phone:217-446-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist