Provider Demographics
NPI:1447847561
Name:VANGILDER, REYNA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REYNA
Middle Name:
Last Name:VANGILDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 HOLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2981
Mailing Address - Country:US
Mailing Address - Phone:304-906-8351
Mailing Address - Fax:
Practice Address - Street 1:1227 HOLMAN AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2981
Practice Address - Country:US
Practice Address - Phone:304-906-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP001099183500000X
OH06013871183500000X
KY021000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist