=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578091476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY THERESE CADDIGAN PHARMD, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2017
-----------------------------------------------------
Last Update Date | 11/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1559 WATASHEAMU RD
-----------------------------------------------------
City | GARDNERVILLE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89460-7455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-265-8622
-----------------------------------------------------
Fax | 775-265-3429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1559 WATASHEAMU RD
-----------------------------------------------------
City | GARDNERVILLE
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89460-7455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-265-8622
-----------------------------------------------------
Fax | 775-265-3429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PST020862
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------