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NPI Code Detail

MEDICARE: DR. KRYSTAL KC RICCIO PHARMD, BCACP, CDCES

MEDICARE: DR. KRYSTAL KC RICCIO PHARMD, BCACP, CDCES
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
11835P2201XAmbulatory Care Pharmacist17625NV
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist17625NV

General Provider Information

NPI Number : 1295964146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRYSTAL KC RICCIO PHARMD, BCACP, CDCES
Provider Business Mailing Address
First Line : 11 SUNSET WAY
Second Line :
City : HENDERSON
State : NV
Zip : 89014-2333
Country : US
Telephone Number : 702-968-5582
Fax Number :
Provider Business Practice Location Address
First Line : 3050 E DESERT INN RD STE 116
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3872
Country : US
Telephone Number : 702-796-0660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2009
Last Update Date : 11/30/2021

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