Provider Demographics
NPI:1932480043
Name:REYNOLDS, SUSAN WILKINS (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WILKINS
Last Name:REYNOLDS
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 1:17421 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-5020
Mailing Address - Country:US
Mailing Address - Phone:434-316-5403
Mailing Address - Fax:434-316-5407
Practice Address - Street 1:17421 FOREST RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-5020
Practice Address - Country:US
Practice Address - Phone:434-316-5403
Practice Address - Fax:434-316-5407
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist