Healthcare Provider Details

I. General information

NPI: 1043138035
Provider Name (Legal Business Name): JORDAN EDWARD CONINE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25160
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: