MEDICARE: MR. RICHARD HIDEMI NAITO

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	16857	NV

General Provider Information

NPI Number	:	1366742413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD HIDEMI NAITO

Provider Business Mailing Address
First Line	:	8341 CELINA HILLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4341
Country	:	US
Telephone Number	:	702-655-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3796
Country	:	US
Telephone Number	:	702-258-9998
Fax Number	:

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

Provider Enumeration Date	:	10/22/2010
Last Update Date	:	10/22/2010

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