Provider Demographics
NPI:1871887356
Name:REYNOLDS, IVYN SCOTT (BSC PHARM)
Entity type:Individual
Prefix:MR
First Name:IVYN
Middle Name:SCOTT
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:BSC PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 N DUSK CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5176
Mailing Address - Country:US
Mailing Address - Phone:509-489-2800
Mailing Address - Fax:
Practice Address - Street 1:5520 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1211
Practice Address - Country:US
Practice Address - Phone:509-489-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00042413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist