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General NPI Number Information
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NPI Number | 1033091152
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Entity Type | Organization
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Legal Business Name | ILY-LARC LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 129 W LAKE MEAD PKWY STE 20
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City | HENDERSON
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State | NV
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Zip | 89015-7055
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Country | US
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Telephone | 702-476-9776
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Fax | 725-910-0743
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Provider Business Mailing Address
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Address Line | 129 W LAKE MEAD PKWY STE 20
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City | HENDERSON
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State | NV
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Zip | 89015-7055
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Country | US
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Telephone | 702-476-9776
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Fax | 725-910-0743
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DR. YVONNE NKWEN-TAMO
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Credential | PHARMD
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Telephone | 702-985-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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