Healthcare Provider Details

I. General information

NPI: 1982980140
Provider Name (Legal Business Name): SARA KAZEMEYNI MONFARED RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
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: 702-655-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15922
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: