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General NPI Number Information
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NPI Number | 1053863605
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEVADA HEALTH DISTRICT
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 280 S DECATUR BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-2936
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Country | US
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Telephone | 702-759-1135
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Fax | 702-759-1440
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Provider Business Mailing Address
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Address Line | PO BOX 3902
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City | LAS VEGAS
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State | NV
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Zip | 89127
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Country | US
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Telephone | 702-759-1135
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION/AO
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Name | ANDREW GLASS
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Credential |
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Telephone | 702-759-0875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH03565
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License Number State | NV
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