Healthcare Provider Details

I. General information

NPI: 1699498865
Provider Name (Legal Business Name): JEREMIAH ANN VERGEL DE DIOS YULO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

8565 LOST GOLD AVE
LAS VEGAS NV
89129-8336
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number23060
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: