MEDICARE: DR. DEEPA BANTHIA

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	18477	NV
2	183500000X	Pharmacist	0202210797	VA

General Provider Information

NPI Number	:	1437584067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPA BANTHIA

Provider Business Mailing Address
First Line	:	210 QUEST PARK ST
Second Line	:	APT. 721
City	:	HENDERSON
State	:	NV
Zip	:	89074-1481
Country	:	US
Telephone Number	:	757-748-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 LAS VEGAS BLVD N
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5756
Country	:	US
Telephone Number	:	757-748-7733
Fax Number	:

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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Directions to “ DR. DEEPA BANTHIA ” Practice Location

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