Healthcare Provider Details

I. General information

NPI: 1134296585
Provider Name (Legal Business Name): SOUTH LYON MEDICAL CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S WHITACRE ST
YERINGTON NV
89447-2561
US

IV. Provider business mailing address

PO BOX 940
YERINGTON NV
89447-0940
US

V. Phone/Fax

Practice location:
  • Phone: 775-463-2301
  • Fax:
Mailing address:
  • Phone: 775-463-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberIB00788
License Number StateNV

VIII. Authorized Official

Name: TONI A INSERRA
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 775-463-6404