Provider Demographics
NPI:1649342403
Name:REYNOLDS, JONATHAN K (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:K
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7425 WRIGLEY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5292
Mailing Address - Country:US
Mailing Address - Phone:509-546-8388
Mailing Address - Fax:855-331-9870
Practice Address - Street 1:7425 WRIGLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5292
Practice Address - Country:US
Practice Address - Phone:509-546-8388
Practice Address - Fax:855-331-9870
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP54121835P1200X
ORRPH-00157091835P1200X
WAPH404081835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy