Provider Demographics
NPI:1710465364
Name:PETTY, JANET LIM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LIM
Last Name:PETTY
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 1:6481 CITORI DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7393
Mailing Address - Country:US
Mailing Address - Phone:775-622-5397
Mailing Address - Fax:
Practice Address - Street 1:1630 ROBB DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-3516
Practice Address - Country:US
Practice Address - Phone:775-746-6411
Practice Address - Fax:775-746-6416
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist