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NPI Code Detail

MEDICARE: WELL CARE APOTHECARY, LLC

MEDICARE: WELL CARE APOTHECARY, 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
1333600000XPharmacyPHC03076NV
23336L0003XLong Term Care PharmacyPH03076NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12155489OTHERPK

General Provider Information

NPI Number : 1144643305
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELL CARE APOTHECARY, LLC
Provider Business Mailing Address
First Line : 3312 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1829
Country : US
Telephone Number : 702-410-7825
Fax Number : 702-946-0409
Provider Business Practice Location Address
First Line : 3300 W CHARLESTON BLVD STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1829
Country : US
Telephone Number : 702-410-7801
Fax Number : 702-988-8806
Authorized Official
Title or Position : GENERAL MANAGER
Name : VANESSA ROBERTS
Credential :
Telephone Number : 702-410-7801
Provider Enumeration Date : 01/23/2014
Last Update Date : 04/17/2024

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Directions to “WELL CARE APOTHECARY, LLC ” Practice Location

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