Healthcare Provider Details

I. General information

NPI: 1124038880
Provider Name (Legal Business Name): STEWART JORGENSEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HOSPITAL ROAD
SCHURZ NV
89427-0500
US

IV. Provider business mailing address

1025 HOSPITAL ROAD P O DRAWER A
SCHURZ NV
89427-0500
US

V. Phone/Fax

Practice location:
  • Phone: 775-773-2345
  • Fax: 775-773-2395
Mailing address:
  • Phone: 775-773-2345
  • Fax: 775-773-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08244
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: