Provider Demographics
NPI:1265557227
Name:REYES, IDABELLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:IDABELLE
Middle Name:
Last Name:REYES
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 1:1224 NEEDLEWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6153
Mailing Address - Country:US
Mailing Address - Phone:407-365-5759
Mailing Address - Fax:
Practice Address - Street 1:700 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8108
Practice Address - Country:US
Practice Address - Phone:407-380-7744
Practice Address - Fax:407-381-4900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018482183500000X
PR2515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050144Medicare ID - Type Unspecified