Healthcare Provider Details

I. General information

NPI: 1861058919
Provider Name (Legal Business Name): KATERINA SEGODNIK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATSIARYNA SIAHODNIK

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 N TENAYA WAY
LAS VEGAS NV
89129
US

IV. Provider business mailing address

3210 N TENAYA WAY
LAS VEGAS NV
89129
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-7840
  • Fax:
Mailing address:
  • Phone: 702-396-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number19753
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: