Healthcare Provider Details

I. General information

NPI: 1104843929
Provider Name (Legal Business Name): BRIAN NEIL MINNICH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOCUST ST
RENO NV
89502-2597
US

IV. Provider business mailing address

2385 AZTEC CT
RENO NV
89511-5659
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberS011242
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS011242
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: