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General NPI Number Information
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NPI Number | 1063825222
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Entity Type | Organization
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Legal Business Name | EZYFAST PHARMACY L L C
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1701 S CASINO DR
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City | LAUGHLIN
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State | NV
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Zip | 89029-1503
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Country | US
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Telephone | 702-298-1701
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Fax | 702-298-1705
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Provider Business Mailing Address
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Address Line | PO BOX 21238
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City | BULLHEAD CITY
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State | AZ
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Zip | 86439-1238
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Country | US
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Telephone | 928-219-5912
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Fax | 928-219-5915
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | EZEKIEL KESITILWE
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Credential |
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Telephone | 928-230-9812
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH03236
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License Number State | NV
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