Healthcare Provider Details

I. General information

NPI: 1679635718
Provider Name (Legal Business Name): ULTRACARE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 CHANDLER AVE STE 11
LAS VEGAS NV
89120-4008
US

IV. Provider business mailing address

2545 CHANDLER AVE STE 11
LAS VEGAS NV
89120-4008
US

V. Phone/Fax

Practice location:
  • Phone: 702-597-0518
  • Fax: 702-597-0519
Mailing address:
  • Phone: 702-597-0518
  • Fax: 702-597-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNV

VIII. Authorized Official

Name: ROBERT TIONGSON BATUNGBACAL
Title or Position: MANAGER
Credential:
Phone: 702-597-0518