Provider Demographics
NPI:1366595589
Name:REITER, GORDON WHITELAW (RPH)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:WHITELAW
Last Name:REITER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LOS COYOTES TRL
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7589
Mailing Address - Country:US
Mailing Address - Phone:928-284-0997
Mailing Address - Fax:
Practice Address - Street 1:HU HU KAM MEMORIAL HOSPITAL POST OFFICE 38
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85247-0038
Practice Address - Country:US
Practice Address - Phone:520-562-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist