Active NPI
Scott E Mambourg, PHARM.D.
- Pharmacotherapy Pharmacist
- Reno, NV
National Provider Identifier
1659398121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 12572
- Practice address
- 1000 Locust St
Attn Pharmacy (119)
Reno, NV 89502-2597 - Phone
- (775) 328-1422
- Fax
- (775) 328-1838
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 12572 | NV | Primary |
| Pharmacotherapy Pharmacist | 1835P1200X | 48274 | CA |
Addresses
Primary practice location
1000 Locust St
Attn Pharmacy (119)
Reno, NV 89502-2597
Mailing address
975 Kirman Ave
Attn Pharmacy (119)
Reno, NV 89502-0993
Phone (775) 328-1422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12572 | NV | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372809600000",
"number": "1659398121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "975 KIRMAN AVE",
"address_2": "ATTN PHARMACY (119)",
"city": "RENO",
"state": "NV",
"postal_code": "895020993",
"telephone_number": "775-328-1422",
"fax_number": "775-328-1838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 LOCUST ST",
"address_2": "ATTN PHARMACY (119)",
"city": "RENO",
"state": "NV",
"postal_code": "895022597",
"telephone_number": "775-328-1422",
"fax_number": "775-328-1838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMBOURG",
"first_name": "SCOTT",
"middle_name": "E",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2013-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "NV",
"license": "12572",
"primary": true
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "CA",
"license": "48274",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.