Provider Demographics
NPI:1700072469
Name:REIST, JEFFREY CLARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CLARK
Last Name:REIST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 76TH AVENUE DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-8929
Mailing Address - Country:US
Mailing Address - Phone:319-848-4031
Mailing Address - Fax:
Practice Address - Street 1:115 SOUTH GRAND AVE
Practice Address - Street 2:ROOM 216
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist