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General NPI Number Information
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NPI Number | 1992145965
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Entity Type | Organization
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Legal Business Name | PHOENIX PHARMACEUTICALS INC
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 6096 S FORT APACHE RD # 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5585
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Country | US
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Telephone | 702-685-1233
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Fax | 702-724-9070
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Provider Business Mailing Address
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Address Line | 6096 S FORT APACHE RD # 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5585
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Country | US
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Telephone | 702-685-1233
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Fax | 702-724-9070
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | JASMINE TA
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Credential |
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Telephone | 702-685-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH02973
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License Number State | NV
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