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General NPI Number Information
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NPI Number | 1164175519
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Entity Type | Organization
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Legal Business Name | MEDTRUST PHARMACY LLC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 3375 E RUSSELL RD # 1G
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City | LAS VEGAS
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State | NV
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Zip | 89120-3472
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Country | US
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Telephone | 702-331-3414
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Fax | 702-331-3413
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Provider Business Mailing Address
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Address Line | 3375 E RUSSELL RD # 1G
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City | LAS VEGAS
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State | NV
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Zip | 89120-3472
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Country | US
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Telephone | 702-331-3414
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Fax | 702-331-3413
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Authorized Official
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Title or Position | CEO
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Name | MAHMOUD MOHAMED NOURELDEEN
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Credential |
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Telephone | 702-331-3414
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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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