Provider Demographics
NPI:1801441811
Name:RECKERT, KEVIN ARTHUR (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ARTHUR
Last Name:RECKERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 E PINON CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3257
Mailing Address - Country:US
Mailing Address - Phone:314-604-1945
Mailing Address - Fax:
Practice Address - Street 1:3831 E PINON CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3257
Practice Address - Country:US
Practice Address - Phone:314-604-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist