MEDICARE: ORNELA KOLICCI PHARMD

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	19984	NV

General Provider Information

NPI Number	:	1316416993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORNELA KOLICCI PHARMD

Provider Business Mailing Address
First Line	:	7806 EXCEL LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3757
Country	:	US
Telephone Number	:	702-408-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:	702-259-7002
Fax Number	:

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

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	11/13/2018

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