MEDICARE: TATIANA SELENE ERIVES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20663	NV

General Provider Information

NPI Number	:	1023614054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA SELENE ERIVES RPH

Provider Business Mailing Address
First Line	:	1244 SEMINOLE LN
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-5565
Country	:	US
Telephone Number	:	702-566-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 E LAKE MEAD PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-4600
Country	:	US
Telephone Number	:	702-558-5101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2020
Last Update Date	:	12/06/2020

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