MEDICARE: DIAMOND 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538996137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND SPECIALTY PHARMACY LLC

Provider Business Mailing Address
First Line	:	4845 S FORT APACHE RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7956
Country	:	US
Telephone Number	:	702-992-3668
Fax Number	:	702-665-4790

Provider Business Practice Location Address
First Line	:	4845 S FORT APACHE RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7956
Country	:	US
Telephone Number	:	702-992-3668
Fax Number	:	702-665-4790

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	DR. EARLMATTHEW PEREGRINO
Credential	:	PHARMD
Telephone Number	:	702-992-3668

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	10/24/2024

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Directions to “DIAMOND SPECIALTY PHARMACY LLC ” Practice Location

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