Provider Demographics
NPI:1104970961
Name:HUMBOLDT GENERAL HOSPITAL PHARMACY
Entity type:Organization
Organization Name:HUMBOLDT GENERAL HOSPITAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCKHORST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:775-623-5222
Mailing Address - Street 1:118 E HASKELL ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3247
Mailing Address - Country:US
Mailing Address - Phone:775-623-5222
Mailing Address - Fax:775-623-5904
Practice Address - Street 1:118 E HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3247
Practice Address - Country:US
Practice Address - Phone:775-623-5222
Practice Address - Fax:775-623-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X
NVIA003153336L0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002807855Medicaid