Provider Demographics
NPI:1144887704
Name:REYNOLDS, CHRISTOPHER JONATHAN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JONATHAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-3333
Mailing Address - Country:US
Mailing Address - Phone:620-421-1357
Mailing Address - Fax:620-421-1384
Practice Address - Street 1:1528 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3333
Practice Address - Country:US
Practice Address - Phone:620-421-1357
Practice Address - Fax:620-421-1384
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist