Healthcare Provider Details

I. General information

NPI: 1205344785
Provider Name (Legal Business Name): THARIT MANOI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W CHEYENNE AVE
LAS VEGAS NV
89129-7262
US

IV. Provider business mailing address

8500 W CHEYENNE AVE
LAS VEGAS NV
89129-7262
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-7258
  • Fax: 702-655-7295
Mailing address:
  • Phone: 702-655-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9144749-1701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19793
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: