MEDICARE: K.ROBINSON HOLDINGS

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1114380227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K.ROBINSON HOLDINGS

Provider Business Mailing Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	# 109 UNIT E
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-496-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	# 109 UNIT E
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-496-5880
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	KELLIE ROBINSON
Credential	:	CPHT
Telephone Number	:	702-496-5880

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/05/2016

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