Provider Demographics
NPI:1922008051
Name:REYNOLDS, KEVIN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:REYNOLDS
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:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:NC
Mailing Address - Zip Code:28750-0311
Mailing Address - Country:US
Mailing Address - Phone:828-894-3311
Mailing Address - Fax:828-894-2151
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-6418
Practice Address - Country:US
Practice Address - Phone:828-894-3311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist