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NPI Code Detail

MEDICARE: MR. WILLIAM HERGENROEDER JR.

MEDICARE: MR. WILLIAM HERGENROEDER JR.
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
1183500000XPharmacist12708NV

General Provider Information

NPI Number : 1649870031
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM HERGENROEDER JR.
Provider Business Mailing Address
First Line : 2004 LADY LAKE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6721
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5200 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1722
Country : US
Telephone Number : 702-367-1003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2020
Last Update Date : 10/27/2020

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