MEDICARE: VINEETA KUMAR JAGTIANI PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	69703	CA

General Provider Information

NPI Number	:	1215890280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINEETA KUMAR JAGTIANI PHARMD

Provider Business Mailing Address
First Line	:	10700 NEW BORO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4405
Country	:	US
Telephone Number	:	702-338-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 NEW BORO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4405
Country	:	US
Telephone Number	:	702-338-5378
Fax Number	:

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

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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