Provider Demographics
NPI:1235730904
Name:DUSSAQ, GINA C (RPH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:C
Last Name:DUSSAQ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 COLGAN CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4416
Mailing Address - Country:US
Mailing Address - Phone:775-722-7807
Mailing Address - Fax:775-853-6427
Practice Address - Street 1:155 DAMONTE RANCH PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2990
Practice Address - Country:US
Practice Address - Phone:775-853-6406
Practice Address - Fax:775-853-6428
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist