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NPI Code Detail

MEDICARE: VESPER SPECIALTY PHARMACY LLC

MEDICARE: VESPER SPECIALTY 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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPH03671NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12168129OTHERPK

General Provider Information

NPI Number : 1376088849
Entity Type Code : Organization
Provider Name (Legal Business Name) : VESPER SPECIALTY PHARMACY LLC
Provider Business Mailing Address
First Line : 4225 S EASTERN AVE STE 16
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5485
Country : US
Telephone Number : 702-333-4377
Fax Number : 702-333-0998
Provider Business Practice Location Address
First Line : 4225 S EASTERN AVE STE 16
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5485
Country : US
Telephone Number : 702-333-4377
Fax Number : 702-333-0998
Authorized Official
Title or Position : OWNER, PIC, AO
Name : JOSHUA KOROGHLI
Credential : RPH
Telephone Number : 702-335-9601
Provider Enumeration Date : 12/20/2016
Last Update Date : 03/17/2017

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Directions to “VESPER SPECIALTY PHARMACY LLC ” Practice Location

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