Healthcare Provider Details

I. General information

NPI: 1629681051
Provider Name (Legal Business Name): ZICXLABETH SEGOVIA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W CHEYENNE AVE
LAS VEGAS NV
89129-7262
US

IV. Provider business mailing address

7043 BRIGHTON VILLAGE ST
LAS VEGAS NV
89166-7101
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-7258
  • Fax:
Mailing address:
  • Phone: 928-208-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19476
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: