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General NPI Number Information
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NPI Number | 1710125091
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Entity Type | Organization
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Legal Business Name | M PHARMACY LLC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 12300 LAS VEGAS BLVD S
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City | HENDERSON
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State | NV
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Zip | 89044-9506
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Country | US
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Telephone | 702-797-1900
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Fax | 702-797-1901
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Provider Business Mailing Address
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Address Line | 12300 LAS VEGAS BLVD S
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City | HENDERSON
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State | NV
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Zip | 89044-9506
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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 | MANAGER
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Name | DAVID VASENDEN
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Credential | RPH
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Telephone | 775-772-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH02472
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License Number State | NV
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