Provider Demographics
NPI:1609395797
Name:REEVES, DAISY (PHARMD)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:REEVES
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 1:9654 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7509
Mailing Address - Country:US
Mailing Address - Phone:316-554-4347
Mailing Address - Fax:
Practice Address - Street 1:512 S KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-4409
Practice Address - Country:US
Practice Address - Phone:843-448-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist