Healthcare Provider Details

I. General information

NPI: 1083807069
Provider Name (Legal Business Name): FARMACIA DEL PUEBLO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 CIVIC CENTER DR
NORTH LAS VEGAS NV
89030-6327
US

IV. Provider business mailing address

2644 KINGHORN PL
HENDERSON NV
89044-8796
US

V. Phone/Fax

Practice location:
  • Phone: 702-399-9477
  • Fax: 702-399-7570
Mailing address:
  • Phone: 702-544-3998
  • Fax: 702-616-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH02238
License Number StateNV

VIII. Authorized Official

Name: CHRISTOPHER TYLER
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 702-544-3998