Provider Demographics
NPI:1457182107
Name:REYNOLDS, REBECCA BOWEN (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BOWEN
Last Name:REYNOLDS
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 1:513 LAKECREST TRL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-2406
Mailing Address - Country:US
Mailing Address - Phone:217-556-7664
Mailing Address - Fax:
Practice Address - Street 1:1305 N CAROLYN DR
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-9326
Practice Address - Country:US
Practice Address - Phone:309-432-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0336551835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric