Healthcare Provider Details

I. General information

NPI: 1407301062
Provider Name (Legal Business Name): CARSON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N CURRY ST
CARSON CITY NV
89703-3975
US

IV. Provider business mailing address

PO BOX 5160
FALLON NV
89407-5160
US

V. Phone/Fax

Practice location:
  • Phone: 775-885-8881
  • Fax:
Mailing address:
  • Phone: 775-423-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH03605
License Number StateNV

VIII. Authorized Official

Name: NATHAN DAHL
Title or Position: MANAGER
Credential:
Phone: 775-423-5491