Provider Demographics
NPI:1982986881
Name:TOLLEY, JOHN ERIC (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
Last Name:TOLLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:TOLLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1588 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2637
Mailing Address - Country:US
Mailing Address - Phone:775-358-8110
Mailing Address - Fax:
Practice Address - Street 1:9705 PYRAMID HWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89441-7541
Practice Address - Country:US
Practice Address - Phone:775-425-9400
Practice Address - Fax:775-425-9409
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV17442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist