Healthcare Provider Details

I. General information

NPI: 1770905440
Provider Name (Legal Business Name): PCPLV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S EASTERN AVE STE 2
LAS VEGAS NV
89119-7851
US

IV. Provider business mailing address

4445 S EASTERN AVE STE B
LAS VEGAS NV
89119-7851
US

V. Phone/Fax

Practice location:
  • Phone: 702-203-8526
  • Fax:
Mailing address:
  • Phone: 702-203-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. CECILIA VENTURA
Title or Position: MANAGER
Credential:
Phone: 702-203-8526