Provider Demographics
NPI:1417533092
Name:WARDLOW, BRIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WARDLOW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0544
Mailing Address - Country:US
Mailing Address - Phone:702-638-1295
Mailing Address - Fax:
Practice Address - Street 1:3655 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0544
Practice Address - Country:US
Practice Address - Phone:702-638-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist