MEDICARE: HAN VERHOEVE

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	14973	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14973	OTHER	NV	LIC #

General Provider Information

NPI Number	:	1104365485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN VERHOEVE

Provider Business Mailing Address
First Line	:	163 WELLSPRING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7616
Country	:	US
Telephone Number	:	702-845-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 WELLSPRING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7616
Country	:	US
Telephone Number	:	702-845-3459
Fax Number	:

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

Provider Enumeration Date	:	02/19/2017
Last Update Date	:	02/19/2017

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Directions to “ HAN VERHOEVE ” Practice Location

Language	Start Address	Practice Location

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