MEDICARE: ASHA KATHRYN THIELE 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	16908	NV

General Provider Information

NPI Number	:	1295014454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA KATHRYN THIELE RPH

Provider Business Mailing Address
First Line	:	1451 CENTER CROSSING RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-7047
Country	:	US
Telephone Number	:	702-880-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 N TENAYA WAY
Second Line	:	T-0826
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6239
Country	:	US
Telephone Number	:	702-396-7840
Fax Number	:	702-396-7840

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

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	01/03/2022

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