MEDICARE: TES OKBAMICHAEL

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	24210	NV

General Provider Information

NPI Number	:	1104704071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TES OKBAMICHAEL

Provider Business Mailing Address
First Line	:	7875 TYRELL PEAKS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5663
Country	:	US
Telephone Number	:	702-619-3575
Fax Number	:

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

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “ TES OKBAMICHAEL ” Practice Location

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