Healthcare Provider Details

I. General information

NPI: 1912155094
Provider Name (Legal Business Name): SIERRA COMPOUNDING PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9738 S VIRGINIA ST STE G
RENO NV
89511-4811
US

IV. Provider business mailing address

9738 S VIRGINIA ST STE G
RENO NV
89511-4811
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-3500
  • Fax: 775-853-3501
Mailing address:
  • Phone: 775-853-3500
  • Fax: 775-853-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHC02377
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID VASENDEN
Title or Position: OWNER
Credential:
Phone: 775-853-3500