Provider Demographics
NPI:1356600530
Name:REED, JOHN ERIC
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERIC
Last Name:REED
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-0374
Mailing Address - Country:US
Mailing Address - Phone:337-468-2893
Mailing Address - Fax:337-468-5932
Practice Address - Street 1:1009 6TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-3123
Practice Address - Country:US
Practice Address - Phone:337-468-5207
Practice Address - Fax:337-468-5932
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist