Provider Demographics
NPI:1881933893
Name:REID, RYAN TAYLOR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TAYLOR
Last Name:REID
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6206
Mailing Address - Country:US
Mailing Address - Phone:757-499-5592
Mailing Address - Fax:757-497-7180
Practice Address - Street 1:748 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6206
Practice Address - Country:US
Practice Address - Phone:757-499-5592
Practice Address - Fax:757-497-7180
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist