Reynolds, Kim M

Reynolds, Kim M is an sole proprietor health care provider with primary practice located at 303 Main St , Massena NY 13662-1903. She recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as her primary health care specialty. Reynolds, Kim M can be contacted via phone (315) 764-0204.

Contact Information

Primary practice address
303 Main St Massena NY 13662-1903
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 042235 New York

Profile Details

NPI number 1205015864
LBN Legal business name Reynolds, Kim M
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 31st, 2007
Last updated Sep 8th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205015864 NPPES
New York MEDICAID 02939004

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