Provider Demographics
NPI:1043932874
Name:REYNA, STEWART PEREZ (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:PEREZ
Last Name:REYNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 GREENLEIGH AVE UNIT 582
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2041
Mailing Address - Country:US
Mailing Address - Phone:443-306-4011
Mailing Address - Fax:
Practice Address - Street 1:2504 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4601
Practice Address - Country:US
Practice Address - Phone:410-662-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist