Provider Demographics
NPI:1730705195
Name:REECE, ELIZABETH LAUREN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:REECE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4204
Mailing Address - Country:US
Mailing Address - Phone:505-326-3342
Mailing Address - Fax:505-325-4694
Practice Address - Street 1:4221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8637
Practice Address - Country:US
Practice Address - Phone:505-325-1749
Practice Address - Fax:505-325-0262
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000092681835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care