=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275931404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UHS RETAIL PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2014
-----------------------------------------------------
Last Update Date | 01/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 E PRATER WAY STE 111
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-9664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-432-7908
-----------------------------------------------------
Fax | 775-343-0107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 E PRATER WAY STE 111
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-9664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-432-7907
-----------------------------------------------------
Fax | 775-343-0102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARVIN PEMBER
-----------------------------------------------------
Credential | BSC PHARMACY
-----------------------------------------------------
Telephone | 610-302-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number | PH03261
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------