Provider Demographics
NPI:1053409482
Name:REICHMAN, ROSS
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:REICHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 ROUTE 507
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4506
Mailing Address - Country:US
Mailing Address - Phone:570-676-0012
Mailing Address - Fax:
Practice Address - Street 1:1547 ROUTE 507
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4506
Practice Address - Country:US
Practice Address - Phone:570-676-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043636L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist