Healthcare Provider Details

I. General information

NPI: 1447273438
Provider Name (Legal Business Name): WASHOE TRIBE OF NEVADA AND CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 WATASHEAMU RD
GARDNERVILLE NV
89460-7455
US

IV. Provider business mailing address

1559 WATASHEAMU RD
GARDNERVILLE NV
89460-7455
US

V. Phone/Fax

Practice location:
  • Phone: 775-265-4215
  • Fax: 775-265-6071
Mailing address:
  • Phone: 775-265-4215
  • Fax: 775-265-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LOREN ELLERY
Title or Position: CLINIC DIRECTOR
Credential: PHARM D
Phone: 775-265-4215