MEDICARE: LAS VEGAS PHARMACY, 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
1	3336C0003X	Community/Retail Pharmacy

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

General Provider Information

NPI Number	:	1134250814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS PHARMACY, INC.

Provider Business Mailing Address
First Line	:	5470 W SAHARA AVE STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3307
Country	:	US
Telephone Number	:	702-220-3906
Fax Number	:	702-220-3919

Provider Business Practice Location Address
First Line	:	5470 W SAHARA AVE # B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3307
Country	:	US
Telephone Number	:	702-220-3906
Fax Number	:	702-220-3919

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MS. LORI A. ORTALE
Credential	:	R.PH.
Telephone Number	:	702-220-3906

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	06/06/2025

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