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General NPI Number Information
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NPI Number | 1447581913
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE RX PHARMACY
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Dates
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Enumeration Date | 01/23/2010
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Last Update Date | 01/23/2010
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Provider Practice Location Address
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Address Line | 840 E TWAIN AVE STE 137
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City | LAS VEGAS
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State | NV
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Zip | 89169-4025
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Country | US
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Telephone | 702-272-2709
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Fax | 702-405-0673
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Provider Business Mailing Address
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Address Line | 840 E TWAIN AVE STE 137
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City | LAS VEGAS
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State | NV
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Zip | 89169-4025
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Country | US
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Telephone | 702-272-2709
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Fax | 702-405-0673
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Authorized Official
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Title or Position | OWNER
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Name | EGHE JERRY IGBINOVIA
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Credential | PHARM. D
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Telephone | 702-595-6265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PH02583
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License Number State | NV
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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 | PH02583
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License Number State | NV
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