Provider Demographics
NPI:1952366726
Name:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE PHARMACY, INC.
Entity Type:Organization
Organization Name:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE PHARMACY, INC.
Other - Org Name:NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAIN
Authorized Official - Middle Name:LO
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:775-784-4800
Mailing Address - Street 1:1664 N. VIRGINIA STREET, MAIL STOP 0318
Mailing Address - Street 2:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE, DEPARTMENT OF
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0318
Mailing Address - Country:US
Mailing Address - Phone:775-784-1348
Mailing Address - Fax:775-784-1620
Practice Address - Street 1:1664 N. VIRGINIA STREET, MAIL STOP 0197
Practice Address - Street 2:UNIVERSITY OF NEVADA SCHOOL OF MEDICINE, CAMPUS PHARMAC
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0197
Practice Address - Country:US
Practice Address - Phone:775-784-6799
Practice Address - Fax:775-784-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00849183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3316043Medicaid
2904755OtherNCPDP
NV2816043Medicaid
NV2904755OtherNCPDP NUMBER