Provider Demographics
NPI:1134794902
Name:REED, GENE JENSEN (183700000X)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:JENSEN
Last Name:REED
Suffix:
Gender:M
Credentials:183700000X
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 494463
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-4463
Mailing Address - Country:US
Mailing Address - Phone:530-515-5348
Mailing Address - Fax:
Practice Address - Street 1:1801 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0434
Practice Address - Country:US
Practice Address - Phone:530-243-5500
Practice Address - Fax:530-243-2437
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149071183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician