Healthcare Provider Details

I. General information

NPI: 1508876996
Provider Name (Legal Business Name): SCOLARI'S #26 PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DISC DR
SPARKS NV
89436-0684
US

IV. Provider business mailing address

1300 DISC DR
SPARKS NV
89436-0684
US

V. Phone/Fax

Practice location:
  • Phone: 775-626-5005
  • Fax: 775-626-4441
Mailing address:
  • Phone: 775-626-5005
  • Fax: 775-626-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number3316320
License Number StateNV

VIII. Authorized Official

Name: MRS. ANGIE SHARP
Title or Position: PHARMACY INSURANCE ADMINISTRATOR
Credential:
Phone: 775-356-2558