Provider Demographics
NPI:1073369344
Name:INDEPENDENCE DRUG LLC
Entity type:Organization
Organization Name:INDEPENDENCE DRUG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERIN
Authorized Official - Middle Name:CORDELL
Authorized Official - Last Name:PASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:775-264-4747
Mailing Address - Street 1:1074 IDAHO ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3907
Mailing Address - Country:US
Mailing Address - Phone:775-264-4747
Mailing Address - Fax:775-204-9188
Practice Address - Street 1:1074 IDAHO ST STE 150
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3907
Practice Address - Country:US
Practice Address - Phone:775-264-4747
Practice Address - Fax:775-204-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy