Healthcare Provider Details

I. General information

NPI: 1760967665
Provider Name (Legal Business Name): PYRAMID LAKE INDIAN HEALTH SERVICE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HIGHWAY 446
NIXON NV
89424
US

IV. Provider business mailing address

1150 FINANCIAL BLVD STE 500
RENO NV
89502-0309
US

V. Phone/Fax

Practice location:
  • Phone: 775-574-1018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: DIRECTOR, NEVADA OPERATIONS
Credential:
Phone: 775-856-6083