Healthcare Provider Details

I. General information

NPI: 1932764032
Provider Name (Legal Business Name): VEGAS PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E FLAMINGO RD STE 216
LAS VEGAS NV
89119-5124
US

IV. Provider business mailing address

2121 E FLAMINGO RD STE 216
LAS VEGAS NV
89119-5124
US

V. Phone/Fax

Practice location:
  • Phone: 775-354-6856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMY DELK
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-351-0208