Provider Demographics
NPI:1356566590
Name:ROWE, REID (RPH)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:
Last Name:ROWE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-3868
Mailing Address - Country:US
Mailing Address - Phone:505-270-0187
Mailing Address - Fax:505-286-5864
Practice Address - Street 1:2B STATE ROAD 344
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6849
Practice Address - Country:US
Practice Address - Phone:505-286-9040
Practice Address - Fax:505-286-9221
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00004368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist