MEDICARE: ASPN PHARMACIES 4, 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1528922937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPN PHARMACIES 4, LLC

Provider Business Mailing Address
First Line	:	1250 S BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8328
Country	:	US
Telephone Number	:	844-267-3251
Fax Number	:	888-336-0556

Provider Business Practice Location Address
First Line	:	1250 S BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8328
Country	:	US
Telephone Number	:	844-267-3251
Fax Number	:	888-336-0556

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	DESIREE ROTH
Credential	:	PHARMACIST
Telephone Number	:	844-267-3251

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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