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General NPI Number Information
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NPI Number | 1366988206
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL RX PHARMACY LLC
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 2560 E SUNSET RD STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89120-3517
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Country | US
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Telephone | 702-478-6690
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Fax | 888-906-3556
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Provider Business Mailing Address
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Address Line | 2560 E SUNSET RD STE 120
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City | LAS VEGAS
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State | NV
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Zip | 89120-3517
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Country | US
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Telephone | 702-478-6690
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Fax | 888-906-3556
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Authorized Official
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Title or Position | OWNER
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Name | MASSIMO CAVALLARO
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Credential |
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Telephone | 702-203-4797
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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 | PH03672
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License Number State | NV
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