Provider Demographics
NPI:1922259936
Name:REIDT, DANIEL J (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:REIDT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W RIVERSIDE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0621
Mailing Address - Country:US
Mailing Address - Phone:509-624-2111
Mailing Address - Fax:509-624-9500
Practice Address - Street 1:601 W RIVERSIDE AVE
Practice Address - Street 2:STE 140
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0621
Practice Address - Country:US
Practice Address - Phone:509-624-2111
Practice Address - Fax:509-624-9500
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028559Medicaid
WA5530540001Medicare NSC