Healthcare Provider Details

I. General information

NPI: 1508517137
Provider Name (Legal Business Name): CHANCE WARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W WENDOVER BLVD
WENDOVER NV
89883
US

IV. Provider business mailing address

1855 W WENDOVER BLVD
WENDOVER NV
89883
US

V. Phone/Fax

Practice location:
  • Phone: 775-664-3197
  • Fax:
Mailing address:
  • Phone: 775-664-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number21098
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: