Provider Demographics
NPI:1023267663
Name:HAROLD K REICH'S PHARMACY
Entity type:Organization
Organization Name:HAROLD K REICH'S PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:209-834-1383
Mailing Address - Street 1:39 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3901
Mailing Address - Country:US
Mailing Address - Phone:209-835-1832
Mailing Address - Fax:209-835-0704
Practice Address - Street 1:1940 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2423
Practice Address - Country:US
Practice Address - Phone:209-834-1383
Practice Address - Fax:888-397-7890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REICH'S PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45237332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA452370Medicaid