Healthcare Provider Details

I. General information

NPI: 1407873482
Provider Name (Legal Business Name): GARY MICHAEL PATCHIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE PHARMACY SERVICE (119)
RENO NV
89502-0993
US

IV. Provider business mailing address

975 KIRMAN AVE PHARMACY SERVICE (119)
RENO NV
89502-0993
US

V. Phone/Fax

Practice location:
  • Phone: 775-328-1449
  • Fax:
Mailing address:
  • Phone: 775-328-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12441
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP4794
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: