Healthcare Provider Details

I. General information

NPI: 1639479165
Provider Name (Legal Business Name): ADVANCED CARE RX PHARMACY 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 02/05/2022
Certification Date: 02/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 WESTCLIFF DR
LAS VEGAS NV
89145-5175
US

IV. Provider business mailing address

7512 WESTCLIFF DR
LAS VEGAS NV
89145-5175
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-6796
  • Fax: 702-629-7130
Mailing address:
  • Phone: 702-331-6796
  • Fax: 702-629-7130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH02656
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH02656
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MOLIH OJONG OROCK
Title or Position: MANAGING OFFICER
Credential: PHARMD
Phone: 702-331-6796