Provider Demographics
NPI:1770790792
Name:PYRAMID LAKE HEALTH CENTER
Entity type:Organization
Organization Name:PYRAMID LAKE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-574-1018
Mailing Address - Street 1:705 HWY 446
Mailing Address - Street 2:PO BOX 227
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424
Mailing Address - Country:US
Mailing Address - Phone:775-574-1018
Mailing Address - Fax:
Practice Address - Street 1:705 HWY 446
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2978926OtherNCPDP NUMBER
BP1582926OtherPHARMACY DEA NUMBER