=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407038698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK REX HARVEY R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 11/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5031 QUIET FALLS CT
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89141-0486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-530-9877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5031 QUIET FALLS CT
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89141-0486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-530-9877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8689
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------