Healthcare Provider Details

I. General information

NPI: 1235885534
Provider Name (Legal Business Name): TAMARA W AVERA PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 MAE ANNE AVE STE 1B
RENO NV
89523-4707
US

IV. Provider business mailing address

6140 MAE ANNE AVE STE 1B
RENO NV
89523-4707
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-1144
  • Fax:
Mailing address:
  • Phone: 775-787-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT21786
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: