Individual
JOHN WALLACE REAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1532 32ND AVE S, FARGO, ND 58103-5987
(701) 280-1928
(701) 280-1402
Mailing address
3319 18TH ST S, FARGO, ND 58104-6537
(701) 232-7589
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3411
ND
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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