Provider Demographics
NPI:1831701929
Name:GAST, REGINALD (PHARMD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:GAST
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 1:1880 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-4064
Mailing Address - Country:US
Mailing Address - Phone:937-322-5894
Mailing Address - Fax:937-322-6323
Practice Address - Street 1:1880 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-4064
Practice Address - Country:US
Practice Address - Phone:937-322-5894
Practice Address - Fax:937-322-6323
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist