Provider Demographics
NPI:1023254141
Name:LINDEN STREET MENTAL HEALTH CENTER PHARMACY
Entity type:Organization
Organization Name:LINDEN STREET MENTAL HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-688-2030
Mailing Address - Street 1:70 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3730
Mailing Address - Country:US
Mailing Address - Phone:775-688-2001
Mailing Address - Fax:775-688-2004
Practice Address - Street 1:480 GALLETTI WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5564
Practice Address - Country:US
Practice Address - Phone:775-688-2001
Practice Address - Fax:775-688-2004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIB024493336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVIB02449OtherPHARMACY LICENSE
FL1147873OtherDEA