MEDICARE: MR. STEPHEN D NOSS JR. TECH

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	183700000X	Pharmacy Technician	PT23216	NV

General Provider Information

NPI Number	:	1477281053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN D NOSS JR. TECH

Provider Business Mailing Address
First Line	:	6178 NEWVILLE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3212
Country	:	US
Telephone Number	:	702-553-8257
Fax Number	:

Provider Business Practice Location Address
First Line	:	4490 PARADISE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-6573
Country	:	US
Telephone Number	:	702-696-7126
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/18/2022

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