MEDICARE: DEFAF ALSMAEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	20248	NV

General Provider Information

NPI Number	:	1003417361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEFAF ALSMAEL

Provider Business Mailing Address
First Line	:	8417 INDIGO SKY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2193
Country	:	US
Telephone Number	:	702-628-6768
Fax Number	:

Provider Business Practice Location Address
First Line	:	6570 E LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7044
Country	:	US
Telephone Number	:	702-437-6441
Fax Number	:	702-437-3590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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Directions to “ DEFAF ALSMAEL ” Practice Location

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