Healthcare Provider Details

I. General information

NPI: 1245332055
Provider Name (Legal Business Name): OMNICARE OF NEVADA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E SUNSET RD SUITE 16
LAS VEGAS NV
89119-4911
US

IV. Provider business mailing address

1 CVS DR BOX 1075
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-4229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN COLBERT
Title or Position: SR DIRECTOR, PAYER RELATIONS
Credential:
Phone: 401-770-2751