Healthcare Provider Details

I. General information

NPI: 1760817167
Provider Name (Legal Business Name): DUKE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 SPECTRUM BLVD
LAS VEGAS NV
89101-4838
US

IV. Provider business mailing address

5710 LBJ FWY SUITE 325
DALLAS TX
75240-6324
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-1899
  • Fax: 877-253-6437
Mailing address:
  • Phone: 214-888-8099
  • Fax: 214-261-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHC02898
License Number StateNV

VIII. Authorized Official

Name: CARY ROSSEL
Title or Position: GENERAL PARTNER, AO
Credential:
Phone: 214-888-8099