Provider Demographics
NPI:1477153641
Name:DRAKE, MARIA ARCHIE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARIA ARCHIE
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 HORSE PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4361
Mailing Address - Country:US
Mailing Address - Phone:775-233-7401
Mailing Address - Fax:
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:776-853-6428
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist