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General NPI Number Information
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NPI Number | 1376508705
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Entity Type | Organization
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Legal Business Name | CAMPUS PHARMACY IV
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 745 WEST MOANA LANE SUITE 100
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City | RENO
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State | NV
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Zip | 89509-4940
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Country | US
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Telephone | 775-334-3030
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Fax | 775-334-3039
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Provider Business Mailing Address
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Address Line | 745 WEST MOANA LANE SUITE 100
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City | RENO
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State | NV
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Zip | 89509-4940
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Country | US
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Telephone | 775-334-3030
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Fax | 775-334-3039
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Authorized Official
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Title or Position | PHARMACIST PHARMACY MANAGER
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Name | MR. KIRK ALAN GARLAND
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Credential | RPH
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Telephone | 775-334-3030
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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 | 14884
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License Number State | NV
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