Provider Demographics
NPI:1043507098
Name:REED, JOHN W JR (R PH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:REED
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7311 JEFFERSON BLVD
Mailing Address - Street 2:T-1513
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-6178
Mailing Address - Country:US
Mailing Address - Phone:502-968-9256
Mailing Address - Fax:502-968-9256
Practice Address - Street 1:7311 JEFFERSON BLVD
Practice Address - Street 2:T-1513
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-6178
Practice Address - Country:US
Practice Address - Phone:502-968-9256
Practice Address - Fax:502-968-9256
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007852183500000X
IN26016533A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist