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NPI Code Detail

MEDICARE: FARMACIA DEL PUEBLO INC

MEDICARE: FARMACIA DEL PUEBLO INC
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
13336C0004XCompounding Pharmacy
23336S0011XSpecialty Pharmacy
3333600000XPharmacy
43336C0003XCommunity/Retail PharmacyPH02238NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12990629OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083807069
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARMACIA DEL PUEBLO INC
Provider Business Mailing Address
First Line : 2644 KINGHORN PL
Second Line :
City : HENDERSON
State : NV
Zip : 89044-8796
Country : US
Telephone Number : 702-544-3998
Fax Number : 702-616-7087
Provider Business Practice Location Address
First Line : 2123 CIVIC CENTER DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-6327
Country : US
Telephone Number : 702-399-9477
Fax Number : 702-399-7570
Authorized Official
Title or Position : PRESIDENT
Name : CHRISTOPHER TYLER
Credential : PHARM.D.
Telephone Number : 702-544-3998
Provider Enumeration Date : 08/22/2007
Last Update Date : 05/22/2012

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Directions to “FARMACIA DEL PUEBLO INC ” Practice Location

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