Individual
GARY T DIRISIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-3578
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-3578
Taxonomy
Speciality
Code
Description
License number
State
208U00000X
Clinical Pharmacology Physician
09138
NV
208U00000X
Clinical Pharmacology Physician
Primary
39645
CA
Other
Enumeration date
10/26/2017
Last updated
09/17/2020
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