Healthcare Provider Details

I. General information

NPI: 1710738356
Provider Name (Legal Business Name): KATELYN OGARA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 NAPA GRAPE CT
LAS VEGAS NV
89135-1418
US

IV. Provider business mailing address

11215 NAPA GRAPE CT
LAS VEGAS NV
89135-1418
US

V. Phone/Fax

Practice location:
  • Phone: 715-566-1502
  • Fax:
Mailing address:
  • Phone: 715-566-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23086
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: