MEDICARE: DR. KENNETH ESTRADA RPH

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	19680	NV

General Provider Information

NPI Number	:	1568067973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ESTRADA RPH

Provider Business Mailing Address
First Line	:	1402 E LAKE MEAD PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-4600
Country	:	US
Telephone Number	:	702-558-5101
Fax Number	:	702-558-5680

Provider Business Practice Location Address
First Line	:	1402 E LAKE MEAD PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-4600
Country	:	US
Telephone Number	:	702-558-5101
Fax Number	:	702-558-5680

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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