Provider Demographics
NPI:1205265162
Name:REYNOLDS, ASHLEY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
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 1:113 MIRIAM LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7309
Mailing Address - Country:US
Mailing Address - Phone:318-469-1473
Mailing Address - Fax:
Practice Address - Street 1:6940 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2516
Practice Address - Country:US
Practice Address - Phone:318-682-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist