Provider Demographics
NPI:1831716620
Name:REINKE, WILLIAM JENNINGS JOHN (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JENNINGS JOHN
Last Name:REINKE
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 1:117 W JANEAUX ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3073
Mailing Address - Country:US
Mailing Address - Phone:406-538-6674
Mailing Address - Fax:
Practice Address - Street 1:117 W JANEAUX ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3073
Practice Address - Country:US
Practice Address - Phone:406-538-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-70427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist