Provider Demographics
NPI:1003583535
Name:SILVER STATE DRUG
Entity type:Organization
Organization Name:SILVER STATE DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-726-3771
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:CALIENTE
Mailing Address - State:NV
Mailing Address - Zip Code:89008-0204
Mailing Address - Country:US
Mailing Address - Phone:775-726-3771
Mailing Address - Fax:
Practice Address - Street 1:414 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:NV
Practice Address - Zip Code:89001-0244
Practice Address - Country:US
Practice Address - Phone:775-725-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER STATE DRUG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy