MEDICARE: DR. JED LESTER BARTOLOME ANISCO 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	19983	NV

General Provider Information

NPI Number	:	1568056208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JED LESTER BARTOLOME ANISCO PHARMD

Provider Business Mailing Address
First Line	:	7960 RAFAEL RIVERA WAY UNIT 1292
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5355
Country	:	US
Telephone Number	:	702-330-7168
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 W CRAIG RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2504
Country	:	US
Telephone Number	:	725-251-2253
Fax Number	:	725-251-2646

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

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	05/06/2022

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