MEDICARE: ANDREW CARAPUCCI

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	20228	NV

General Provider Information

NPI Number	:	1396375457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CARAPUCCI

Provider Business Mailing Address
First Line	:	2451 N RAINBOW BLVD UNIT 1151
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 LAS VEGAS BLVD N
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5840
Country	:	US
Telephone Number	:	702-642-0892
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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