Provider Demographics
NPI:1780052431
Name:REED, MAKITA DEMETRIUS (PHARMD)
Entity type:Individual
Prefix:MS
First Name:MAKITA
Middle Name:DEMETRIUS
Last Name:REED
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 PINEHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6687
Mailing Address - Country:US
Mailing Address - Phone:901-830-7077
Mailing Address - Fax:
Practice Address - Street 1:8700 W TRAIL LAKE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8205
Practice Address - Country:US
Practice Address - Phone:901-309-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE14002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist