Provider Demographics
NPI:1801998695
Name:FLAHERTY, REED FREDERICK (RPH)
Entity type:Individual
Prefix:MR
First Name:REED
Middle Name:FREDERICK
Last Name:FLAHERTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 W INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISIANA
Mailing Address - State:MO
Mailing Address - Zip Code:63353-3868
Mailing Address - Country:US
Mailing Address - Phone:573-248-8015
Mailing Address - Fax:
Practice Address - Street 1:3651 W INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-3868
Practice Address - Country:US
Practice Address - Phone:573-248-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist