Healthcare Provider Details

I. General information

NPI: 1013460302
Provider Name (Legal Business Name): JASON MCCOMB PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9738 S VIRGINIA ST STE F
RENO NV
89511-5930
US

IV. Provider business mailing address

9738 S VIRGINIA ST STE F
RENO NV
89511-5930
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-3502
  • Fax: 775-236-5771
Mailing address:
  • Phone: 775-853-3502
  • Fax: 775-236-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17364
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number17364
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: