MEDICARE: DR. REGGIE HIDALGO MAYNIGO PHARM.D.

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	16169	NV

General Provider Information

NPI Number	:	1205841178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGGIE HIDALGO MAYNIGO PHARM.D.

Provider Business Mailing Address
First Line	:	9308 ROPING COWBOY AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178
Country	:	US
Telephone Number	:	702-234-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	9308 ROPING COWBOY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6250
Country	:	US
Telephone Number	:	702-234-9910
Fax Number	:

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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