Healthcare Provider Details

I. General information

NPI: 1164002663
Provider Name (Legal Business Name): CAROL ENG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-3408
US

IV. Provider business mailing address

1428 CLIPPERTON AVE
HENDERSON NV
89074-1622
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-1920
  • Fax:
Mailing address:
  • Phone: 702-898-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15754
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: