Healthcare Provider Details

I. General information

NPI: 1568472967
Provider Name (Legal Business Name): SCOLARIS WAREHOUSE MARKETS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 95A N
FERNLEY NV
89408-7675
US

IV. Provider business mailing address

1400 US HIGHWAY 95A N
FERNLEY NV
89408-7675
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-5065
  • Fax: 775-575-2619
Mailing address:
  • Phone: 775-575-5065
  • Fax: 775-575-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number3310100
License Number StateNV

VIII. Authorized Official

Name: MR. ALMA D TREJO
Title or Position: PHARMACY INSRUANCE ADMINISTRATOR
Credential:
Phone: 775-785-7396