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NPI Code Detail

MEDICARE: VEGAS PHARMACY LLC

MEDICARE: VEGAS PHARMACY LLC
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
13336C0004XCompounding Pharmacy
23336L0003XLong Term Care Pharmacy
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PHC04324OTHERNVNV STATE BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number : 1508452780
Entity Type Code : Organization
Provider Name (Legal Business Name) : VEGAS PHARMACY LLC
Provider Business Mailing Address
First Line : 8352 W WARM SPRINGS RD STE 330
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-3631
Country : US
Telephone Number : 702-410-5620
Fax Number : 702-444-4021
Provider Business Practice Location Address
First Line : 8352 W WARM SPRINGS RD STE 330
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-3631
Country : US
Telephone Number : 702-410-5620
Fax Number : 702-444-4021
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : BRADLY LENDE
Credential : PHARM.D
Telephone Number : 702-410-5620
Provider Enumeration Date : 12/11/2020
Last Update Date : 03/07/2023

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Directions to “VEGAS PHARMACY LLC ” Practice Location

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