Provider Demographics
NPI:1841892395
Name:ROOT, SETH RYAN (RPH)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:RYAN
Last Name:ROOT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-6848
Mailing Address - Country:US
Mailing Address - Phone:775-746-4809
Mailing Address - Fax:775-746-4863
Practice Address - Street 1:10370 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-6848
Practice Address - Country:US
Practice Address - Phone:775-746-4809
Practice Address - Fax:775-746-4863
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist