MEDICARE: GUS DAVID

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	18005	NV

General Provider Information

NPI Number	:	1447766183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUS DAVID

Provider Business Mailing Address
First Line	:	2604 ROCK PIGEON AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 SIMMONS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-9005
Country	:	US
Telephone Number	:	702-646-2650
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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Directions to “ GUS DAVID ” Practice Location

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