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NPI Code Detail

MEDICARE: GINA C DUSSAQ RPH

MEDICARE: GINA C DUSSAQ RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist09996NV

General Provider Information

NPI Number : 1235730904
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA C DUSSAQ RPH
Provider Business Mailing Address
First Line : 2174 COLGAN CT
Second Line :
City : RENO
State : NV
Zip : 89521-4416
Country : US
Telephone Number : 775-722-7807
Fax Number : 775-853-6427
Provider Business Practice Location Address
First Line : 155 DAMONTE RANCH PKWY
Second Line :
City : RENO
State : NV
Zip : 89521-2990
Country : US
Telephone Number : 775-853-6406
Fax Number : 775-853-6428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2020
Last Update Date : 11/07/2020

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