Basic Information
| Provider Information | |||||||||
| NPI: | 1922008051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 311 | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287500311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
| FaxNumber: | 8288942151 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287226418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 12676 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.