Provider Demographics
NPI:1205573581
Name:REICHENBACH, ROBERT DONALD
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DONALD
Last Name:REICHENBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8418 EXCALIBER PL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-4705
Mailing Address - Country:US
Mailing Address - Phone:419-235-6263
Mailing Address - Fax:
Practice Address - Street 1:2207 POCAHONTAS TRL
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1633
Practice Address - Country:US
Practice Address - Phone:804-932-4336
Practice Address - Fax:804-932-8963
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022194601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty