Healthcare Provider Details

I. General information

NPI: 1346919149
Provider Name (Legal Business Name): TERI KEZAR PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 N MCCARRAN BLVD
RENO NV
89503-1873
US

IV. Provider business mailing address

4955 JACKRABBIT RD
RENO NV
89510-9567
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-5717
  • Fax: 775-746-2308
Mailing address:
  • Phone: 775-750-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13740
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: