Provider Demographics
NPI:1790153773
Name:REYNAUD, DAVID NICOLAS ALLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICOLAS ALLEN
Last Name:REYNAUD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NW 16TH ST
Mailing Address - Street 2:PHARMACY (119)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1624
Mailing Address - Country:US
Mailing Address - Phone:305-212-4901
Mailing Address - Fax:305-575-3386
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:PHARMACY (119)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-212-4901
Practice Address - Fax:305-575-3386
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist