MEDICARE: PAC LP

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1275957136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAC LP

Provider Business Mailing Address
First Line	:	PO BOX 401721
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-1721
Country	:	US
Telephone Number	:	800-610-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	9465 W POST ROAD
Second Line	:	SUITE 1068
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5786
Country	:	US
Telephone Number	:	562-587-6862
Fax Number	:	866-645-1202

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. KHALID BASHIR AHMED
Credential	:	MD
Telephone Number	:	800-610-6353

Provider Enumeration Date	:	02/13/2014
Last Update Date	:	02/13/2014

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