Provider Demographics
NPI:1851897664
Name:COMMUNITY HEALTH ALLIANCE
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ALLIANCE
Other - Org Name:COMMUNITY HEALTH ALLIANCE - SPARKS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-336-3003
Mailing Address - Street 1:2244 ODDIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-7574
Mailing Address - Country:US
Mailing Address - Phone:775-997-7303
Mailing Address - Fax:775-997-7353
Practice Address - Street 1:2244 ODDIE BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-7574
Practice Address - Country:US
Practice Address - Phone:775-997-7300
Practice Address - Fax:775-997-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy