Healthcare Provider Details

I. General information

NPI: 1669038790
Provider Name (Legal Business Name): HEMOSTASIS & THROMBOSIS CENTER OF NV PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

IV. Provider business mailing address

8352 W WARM SPRINGS RD STE 200
LAS VEGAS NV
89113-3629
US

V. Phone/Fax

Practice location:
  • Phone: 792-960-5991
  • Fax: 702-832-1128
Mailing address:
  • Phone: 702-960-5991
  • Fax: 702-832-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER MARIE FEDERIZO
Title or Position: DIRECTOR OF ADULT SERVICES
Credential:
Phone: 702-960-5712