1114937364 NPI number — SCOLARI'S #23 PHARMACY

Table of content: (NPI 1114937364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114937364 NPI number — SCOLARI'S #23 PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOLARI'S #23 PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114937364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 HWY. 395 SOUTH
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
GARDNERVILLE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-782-5530
Provider Business Mailing Address Fax Number:
775-782-5592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 HWY. 395 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
GARDNERVILLE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-782-5530
Provider Business Practice Location Address Fax Number:
775-782-5592
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHARP
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY INSURANCE ADMINISTRATOR
Authorized Official Telephone Number:
775-356-2558

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  3303525 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3303525 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com