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General NPI Number Information
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NPI Number | 1326488784
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Entity Type | Organization
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Legal Business Name | PMKM LLC
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 801 S RANCHO DR # 7
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City | LAS VEGAS
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State | NV
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Zip | 89106-3854
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Country | US
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Telephone | 702-478-5133
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Fax | 702-478-5401
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Provider Business Mailing Address
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Address Line | 801 S RANCHO DR # 7
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City | LAS VEGAS
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State | NV
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Zip | 89106-3854
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Country | US
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Telephone | 702-478-5133
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Fax | 702-478-5401
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP MONTANO
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Credential |
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Telephone | 818-848-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy 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 | 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 #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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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 #6
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PHC02986
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License Number State | NV
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