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NPI Code Detail

MEDICARE: VANCE HARDY PHARMACIST

MEDICARE:   VANCE  HARDY  PHARMACIST
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
1183500000XPharmacist17220NV

General Provider Information

NPI Number : 1568065167
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANCE HARDY PHARMACIST
Provider Business Mailing Address
First Line : 6868 DESERT ISLAND ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-0702
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2425 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3616
Country : US
Telephone Number : 702-734-0258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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Directions to “ VANCE HARDY PHARMACIST” Practice Location

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