MEDICARE: MATIN BHATT

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	16389	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16389	OTHER	NV	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1679213052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATIN BHATT

Provider Business Mailing Address
First Line	:	5082 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-3666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5082 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-3666
Country	:	US
Telephone Number	:	702-531-2038
Fax Number	:

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

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	03/31/2022

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Directions to “ MATIN BHATT ” Practice Location

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