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General NPI Number Information
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NPI Number | 1518235241
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Entity Type | Individual
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Provider Name | TAMARA BOLOS ALLEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 4155 S GRAND CANYON DR T-1524
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City | LAS VEGAS
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State | NV
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Zip | 89147-7123
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Country | US
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Telephone | 702-251-1450
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Fax | 702-251-1450
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Provider Business Mailing Address
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Address Line | 4155 S GRAND CANYON DR T-1524
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City | LAS VEGAS
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State | NV
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Zip | 89147-7123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 16934
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License Number State | NV
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