Healthcare Provider Details

I. General information

NPI: 1972603827
Provider Name (Legal Business Name): LIFECARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/10/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 E DESERT INN RD STE 124
LAS VEGAS NV
89121-3873
US

IV. Provider business mailing address

3050 E DESERT INN RD STE 124
LAS VEGAS NV
89121-3873
US

V. Phone/Fax

Practice location:
  • Phone: 702-697-2105
  • Fax: 702-697-2107
Mailing address:
  • Phone: 702-697-2105
  • Fax: 702-697-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: CLETUS ONYE AMADI
Title or Position: PHARMACIST /OWNER
Credential: R.PH.
Phone: 702-697-2105