MEDICARE: LGCM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	3336S0011X	Specialty Pharmacy
4	333600000X	Pharmacy

General Provider Information

NPI Number	:	1639671324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGCM LLC

Provider Business Mailing Address
First Line	:	70 E HORIZON RIDGE PKWY STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-7936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 E HORIZON RIDGE PKWY STE 140
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-7936
Country	:	US
Telephone Number	:	702-750-0475
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLARE-LANIE GUERRERO MACARAEG
Credential	:
Telephone Number	:	702-750-0475

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	10/22/2018

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