Healthcare Provider Details

I. General information

NPI: 1255116695
Provider Name (Legal Business Name): KHYSNER CARINHAY SAMACO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE
RENO NV
89502-0993
US

IV. Provider business mailing address

7057 BANNISTER RD
SPARKS NV
89436-8194
US

V. Phone/Fax

Practice location:
  • Phone: 775-785-7267
  • Fax:
Mailing address:
  • Phone: 151-841-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30162833
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: