Healthcare Provider Details

I. General information

NPI: 1871504381
Provider Name (Legal Business Name): FERNLEY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E MAIN ST
FERNLEY NV
89408-9743
US

IV. Provider business mailing address

PO BOX 5160
FALLON NV
89407-5160
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-4435
  • Fax: 775-575-2670
Mailing address:
  • Phone: 775-423-5491
  • Fax: 775-575-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHN03516
License Number StateNV

VIII. Authorized Official

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