Provider Demographics
NPI:1790066371
Name:REINERTSEN, DAVID BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:REINERTSEN
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 1:2235 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-4025
Mailing Address - Country:US
Mailing Address - Phone:484-365-1010
Mailing Address - Fax:484-363-1006
Practice Address - Street 1:2235 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-4025
Practice Address - Country:US
Practice Address - Phone:484-365-1010
Practice Address - Fax:484-363-1006
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029633L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist