MEDICARE: ALI RAZA LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH03704	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2166298	OTHER		PK

General Provider Information

NPI Number	:	1053866558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI RAZA LLC

Provider Business Mailing Address
First Line	:	1131 E TROPICANA AVE # A-1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6601
Country	:	US
Telephone Number	:	702-816-4277
Fax Number	:	702-816-5469

Provider Business Practice Location Address
First Line	:	1131 E TROPICANA AVE # A-1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6601
Country	:	US
Telephone Number	:	702-816-4277
Fax Number	:	702-816-5469

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	NUREEN RAZA
Credential	:
Telephone Number	:	702-816-4277

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	04/07/2017

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Directions to “ALI RAZA LLC ” Practice Location

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