Provider Demographics
NPI:1255539136
Name:GAGLIARDI, JOHN M (PHARMBS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:PHARMBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-982-5281
Mailing Address - Fax:775-982-5250
Practice Address - Street 1:21 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-982-5281
Practice Address - Fax:775-982-5250
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29179OtherPHARMACIST LICENSE
NV6199OtherPHARMACIST LICENSE