MEDICARE: MEDTRUST PHARMACY LLC

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	:	1164175519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTRUST PHARMACY LLC

Provider Business Mailing Address
First Line	:	3375 E RUSSELL RD # 1G
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3472
Country	:	US
Telephone Number	:	702-331-3414
Fax Number	:	702-331-3413

Provider Business Practice Location Address
First Line	:	3375 E RUSSELL RD # 1G
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3472
Country	:	US
Telephone Number	:	702-331-3414
Fax Number	:	702-331-3413

Authorized Official
Title or Position	:	CEO
Name	:	MAHMOUD MOHAMED NOURELDEEN
Credential	:
Telephone Number	:	702-331-3414

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	04/04/2025

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