MEDICARE: DAVID KOGAN

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	19727	NV

General Provider Information

NPI Number	:	1003695420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KOGAN

Provider Business Mailing Address
First Line	:	10312 TOWER RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8124
Country	:	US
Telephone Number	:	702-325-3120
Fax Number	:

Provider Business Practice Location Address
First Line	:	10312 TOWER RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8124
Country	:	US
Telephone Number	:	702-325-3120
Fax Number	:

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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Directions to “ DAVID KOGAN ” Practice Location

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