Provider Demographics
NPI:1861213381
Name:VILLANUEVA REYES, LUIS ALEJANDRO (PHARMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEJANDRO
Last Name:VILLANUEVA REYES
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 1:50 PEYTON RANDOLPH CT
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-8717
Mailing Address - Country:US
Mailing Address - Phone:786-444-5461
Mailing Address - Fax:
Practice Address - Street 1:50 PEYTON RANDOLPH CT
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-8717
Practice Address - Country:US
Practice Address - Phone:786-444-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0203020699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist