Healthcare Provider Details

I. General information

NPI: 1043650294
Provider Name (Legal Business Name): PAMELA OBAH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N MCCARRAN BLVD
SPARKS NV
89431-4600
US

IV. Provider business mailing address

680 N MCCARRAN BLVD
SPARKS NV
89431-4600
US

V. Phone/Fax

Practice location:
  • Phone: 775-359-6808
  • Fax:
Mailing address:
  • Phone: 775-359-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18363
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: