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NPI Code Detail

MEDICARE: ROBERT MIRAVITE RPH

MEDICARE: ROBERT MIRAVITE 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
1183500000XPharmacist17647NV

General Provider Information

NPI Number : 1255613964
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT MIRAVITE RPH
Provider Business Mailing Address
First Line : 2412 SATELLITE BEACH DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89134-0405
Country : US
Telephone Number : 702-785-4563
Fax Number :
Provider Business Practice Location Address
First Line : 4905 W TROPICANA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5077
Country : US
Telephone Number : 702-889-0922
Fax Number : 702-889-0915
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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