MEDICARE: PLUS ONE PHARMACY, 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1205442928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUS ONE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	6545 S FORT APACHE RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6758
Country	:	US
Telephone Number	:	702-720-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 S FORT APACHE RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6758
Country	:	US
Telephone Number	:	702-720-4006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANISHA PATEL
Credential	:
Telephone Number	:	702-720-4006

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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