MEDICARE: C & R PHARMACY

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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy	PH02759	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2133755	OTHER		PK

General Provider Information

NPI Number	:	1023380219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & R PHARMACY

Provider Business Mailing Address
First Line	:	2202 W CHARLESTON BLVD
Second Line	:	STE 13
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2232
Country	:	US
Telephone Number	:	702-384-3784
Fax Number	:	702-384-3796

Provider Business Practice Location Address
First Line	:	2202 W CHARLESTON BLVD
Second Line	:	STE 13
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2232
Country	:	US
Telephone Number	:	702-384-3784
Fax Number	:	702-384-3796

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENNETH HEATON
Credential	:	RPH
Telephone Number	:	702-384-3784

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	01/18/2017

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Directions to “C & R PHARMACY ” Practice Location

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