MEDICARE: FIRST CLASS RX 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	PH03310	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150374	OTHER		PK

General Provider Information

NPI Number	:	1205228731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CLASS RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	3783 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3338
Country	:	US
Telephone Number	:	702-534-0325
Fax Number	:	702-534-0336

Provider Business Practice Location Address
First Line	:	3783 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3338
Country	:	US
Telephone Number	:	702-534-0325
Fax Number	:	702-534-0336

Authorized Official
Title or Position	:	OWNER
Name	:	SANDRA MARTIN
Credential	:
Telephone Number	:	702-534-0325

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	05/07/2020

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Directions to “FIRST CLASS RX PHARMACY LLC ” Practice Location

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