MEDICARE: DR. BLAIR BARDELMEIER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20393	NV

General Provider Information

NPI Number	:	1902444763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR BARDELMEIER PHARMD

Provider Business Mailing Address
First Line	:	690 E PATRIOT BLVD APT 330
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-1243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 US HIGHWAY 395 N
Second Line	:
City	:	GARDNERVILLE
State	:	NV
Zip	:	89410-5391
Country	:	US
Telephone Number	:	775-782-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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