MEDICARE: CHONLADA CHEWJALEARN

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	16754	NV

General Provider Information

NPI Number	:	1740575448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHONLADA CHEWJALEARN

Provider Business Mailing Address
First Line	:	3550 S RAINBOW BLVD
Second Line	:	T-0850
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1004
Country	:	US
Telephone Number	:	702-252-4600
Fax Number	:	702-525-4600

Provider Business Practice Location Address
First Line	:	3550 S RAINBOW BLVD
Second Line	:	T-0850
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1004
Country	:	US
Telephone Number	:	702-252-4600
Fax Number	:	702-252-4600

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

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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Directions to “ CHONLADA CHEWJALEARN ” Practice Location

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