Provider Demographics
NPI:1700542032
Name:PICKETT, LOUIS MICHAEL
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MICHAEL
Last Name:PICKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:MICHAEL
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:738 KINSLI ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-4104
Mailing Address - Country:US
Mailing Address - Phone:702-496-5427
Mailing Address - Fax:
Practice Address - Street 1:2020 RENO HWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2627
Practice Address - Country:US
Practice Address - Phone:775-428-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV163461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV738OtherHELP
NV7798787Medicaid