Healthcare Provider Details

I. General information

NPI: 1023380219
Provider Name (Legal Business Name): C & R PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 W CHARLESTON BLVD STE 13
LAS VEGAS NV
89102-2232
US

IV. Provider business mailing address

2202 W CHARLESTON BLVD STE 13
LAS VEGAS NV
89102-2232
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-3784
  • Fax: 702-384-3796
Mailing address:
  • Phone: 702-384-3784
  • Fax: 702-384-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH02759
License Number StateNV

VIII. Authorized Official

Name: KENNETH HEATON
Title or Position: PRESIDENT
Credential: RPH
Phone: 702-384-3784