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General NPI Number Information
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NPI Number | 1164019923
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Entity Type | Individual
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Provider Name | CORY WM KILGALLEN PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 292 LOS ALTOS PKWY
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City | SPARKS
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State | NV
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Zip | 89436-7708
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Country | US
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Telephone | 775-354-0104
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Fax | 775-354-0122
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Provider Business Mailing Address
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Address Line | 1040 BOWMAN DR
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City | RENO
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State | NV
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Zip | 89503-3452
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Country | US
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Telephone | 775-636-0510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20758
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License Number State | NV
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