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General NPI Number Information
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NPI Number | 1104330059
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Entity Type | Organization
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Legal Business Name | PINNACLE ABSOLUTE CARE
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 114 N. SANDHILL BLVD, SUITE B
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City | MESQUITE
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State | NV
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Zip | 89027
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Country | US
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Telephone | 702-346-3844
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Fax | 702-346-1718
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Provider Business Mailing Address
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Address Line | 114 N. SANDHILL BLVD, SUITE B
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City | MESQUITE
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State | NV
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Zip | 89027
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Country | US
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Telephone | 702-346-3844
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Fax | 702-346-1718
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Authorized Official
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Title or Position | OWNER/MANAGING PHARMACIST
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Name | DR. EMMANUEL KODJOE
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Credential | PHARMD
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Telephone | 702-346-3844
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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 | PH03818
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License Number State | NV
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