Healthcare Provider Details

I. General information

NPI: 1144065210
Provider Name (Legal Business Name): AMANDA JEPPESEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
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: 775-982-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24227
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: