Healthcare Provider Details

I. General information

NPI: 1013830090
Provider Name (Legal Business Name): MUHAMMAD FAROOQ AZAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR STE G46
LAS VEGAS NV
89106-4835
US

IV. Provider business mailing address

1355 OSSA ST UNIT 1101
HENDERSON NV
89052-8824
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-4844
  • Fax:
Mailing address:
  • Phone: 702-661-7945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25254
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: