Provider Demographics
NPI:1083962989
Name:SIERRA COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:SIERRA COMPOUNDING PHARMACY
Other - Org Name:HALE'S PHRAMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-853-3500
Mailing Address - Street 1:901 E 2ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1175
Mailing Address - Country:US
Mailing Address - Phone:775-322-2171
Mailing Address - Fax:775-322-8902
Practice Address - Street 1:901 E 2ND ST
Practice Address - Street 2:STE 102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1175
Practice Address - Country:US
Practice Address - Phone:775-322-2171
Practice Address - Fax:775-322-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH007343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2993055OtherNCPDP PROVIDER IDENTIFICATION NUMBER