Provider Demographics
NPI:1821275173
Name:REINHARDT, JILL (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
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:PO BOX 770
Mailing Address - Street 2:660 3RD STREET
Mailing Address - City:GAYLORD
Mailing Address - State:MN
Mailing Address - Zip Code:55334-0770
Mailing Address - Country:US
Mailing Address - Phone:507-237-2933
Mailing Address - Fax:507-237-2935
Practice Address - Street 1:660 3RD ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MN
Practice Address - Zip Code:55334-2297
Practice Address - Country:US
Practice Address - Phone:507-237-2933
Practice Address - Fax:507-237-2935
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115835-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN869676400Medicaid
MN869676400Medicaid