MEDICARE: LAS VEGAS MEDICAL STORE

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1518407741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS MEDICAL STORE

Provider Business Mailing Address
First Line	:	4523 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3760
Country	:	US
Telephone Number	:	702-803-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3760
Country	:	US
Telephone Number	:	702-803-1365
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ARMENAK MURADYAN
Credential	:
Telephone Number	:	702-601-4622

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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Directions to “LAS VEGAS MEDICAL STORE ” Practice Location

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