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General NPI Number Information
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NPI Number | 1558619569
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Entity Type | Individual
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Provider Name | MARK SUNTAY PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 4875 S FORT APACHE RD
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City | LAS VEGAS
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State | NV
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Zip | 89147-7944
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Country | US
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Telephone | 702-873-5165
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Fax |
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Provider Business Mailing Address
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Address Line | 8975 W WARM SPRINGS RD APT 2027
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City | LAS VEGAS
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State | NV
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Zip | 89148-2895
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Country | US
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Telephone | 513-675-8550
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18305
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License Number State | NV
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