Provider Demographics
NPI:1831729268
Name:WILLIAM BEE RIRIE RETAIL PHARMACY
Entity type:Organization
Organization Name:WILLIAM BEE RIRIE RETAIL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:RUVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-289-3001
Mailing Address - Street 1:1500 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2615
Mailing Address - Country:US
Mailing Address - Phone:775-289-2338
Mailing Address - Fax:775-549-8500
Practice Address - Street 1:1500 AVENUE H
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2615
Practice Address - Country:US
Practice Address - Phone:775-289-2338
Practice Address - Fax:775-549-8500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM BEE RIRIE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-24
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487648804Medicaid