Healthcare Provider Details

I. General information

NPI: 1417977307
Provider Name (Legal Business Name): JERRY HOWARD CLIFFORD PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOCUST ST # 119
RENO NV
89502-2597
US

IV. Provider business mailing address

1000 LOCUST ST # 119
RENO NV
89502-2597
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10797
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: