MEDICARE: JIM JUSON RPH

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	15360	NV

General Provider Information

NPI Number	:	1275120800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM JUSON RPH

Provider Business Mailing Address
First Line	:	434 FIDDLEHEAD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4653
Country	:	US
Telephone Number	:	866-787-6341
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 FIDDLEHEAD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4653
Country	:	US
Telephone Number	:	866-787-6341
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	12/30/2020

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Directions to “ JIM JUSON RPH” Practice Location

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