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General NPI Number Information
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NPI Number | 1023380219
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Entity Type | Organization
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Legal Business Name | C & R PHARMACY
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 2202 W CHARLESTON BLVD STE 13
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City | LAS VEGAS
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State | NV
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Zip | 89102-2232
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Country | US
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Telephone | 702-384-3784
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Fax | 702-384-3796
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Provider Business Mailing Address
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Address Line | 2202 W CHARLESTON BLVD STE 13
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City | LAS VEGAS
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State | NV
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Zip | 89102-2232
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Country | US
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Telephone | 702-384-3784
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Fax | 702-384-3796
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH HEATON
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Credential | RPH
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Telephone | 702-384-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH02759
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License Number State | NV
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