Healthcare Provider Details

I. General information

NPI: 1508452780
Provider Name (Legal Business Name): VEGAS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 03/07/2023
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 W WARM SPRINGS RD STE 330
LAS VEGAS NV
89113-3631
US

IV. Provider business mailing address

8352 W WARM SPRINGS RD STE 330
LAS VEGAS NV
89113-3631
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-5620
  • Fax: 702-444-4021
Mailing address:
  • Phone: 702-410-5620
  • Fax: 702-444-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRADLY LENDE
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 702-410-5620