Healthcare Provider Details

I. General information

NPI: 1033434022
Provider Name (Legal Business Name): NEVADA DRUG COMPOUNDING PHARMACY EAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 W HORIZON RIDGE PKWY #100
HENDERSON NV
89052-3948
US

IV. Provider business mailing address

3041 W HORIZON RIDGE PKWY #100
HENDERSON NV
89052-3948
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-6900
  • Fax:
Mailing address:
  • Phone: 702-293-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH01713
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH01713
License Number StateNV

VIII. Authorized Official

Name: MR. GLENN TRUITT
Title or Position: GENERAL COUNSEL
Credential:
Phone: 702-564-2079