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NPI Code Detail

MEDICARE: DIVINE TOUCH SERVICES PHARMACY & COMPOUNDING

MEDICARE: DIVINE TOUCH SERVICES PHARMACY & COMPOUNDING
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0004XCompounding Pharmacy
43336C0003XCommunity/Retail PharmacyPH03411NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12152990OTHERPK

General Provider Information

NPI Number : 1306220843
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE TOUCH SERVICES PHARMACY & COMPOUNDING
Provider Business Mailing Address
First Line : 2208 E CHARLESTON BLVD STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-2049
Country : US
Telephone Number : 702-331-0887
Fax Number : 702-331-5127
Provider Business Practice Location Address
First Line : 2208 E CHARLESTON BLVD STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-2049
Country : US
Telephone Number : 702-331-0887
Fax Number : 702-331-5127
Authorized Official
Title or Position : CEO/ PHARMACIST
Name : JOSHUA AIGHOBAHI
Credential :
Telephone Number : 702-331-0887
Provider Enumeration Date : 07/15/2015
Last Update Date : 09/04/2015

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Directions to “DIVINE TOUCH SERVICES PHARMACY & COMPOUNDING ” Practice Location

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