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NPI Code Detail

MEDICARE: ADVANCED CARE RX PHARMACY 1, LLC

MEDICARE: ADVANCED CARE RX PHARMACY 1, 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 PharmacyPH02656NV
23336L0003XLong Term Care Pharmacy
33336C0003XCommunity/Retail PharmacyPH02656NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639479165
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED CARE RX PHARMACY 1, LLC
Provider Business Mailing Address
First Line : 7512 WESTCLIFF DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-5175
Country : US
Telephone Number : 702-331-6796
Fax Number : 702-629-7130
Provider Business Practice Location Address
First Line : 7512 WESTCLIFF DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89145-5175
Country : US
Telephone Number : 702-331-6796
Fax Number : 702-629-7130
Authorized Official
Title or Position : MANAGING OFFICER
Name : MR. MOLIH OJONG OROCK
Credential : PHARMD
Telephone Number : 702-331-6796
Provider Enumeration Date : 11/01/2010
Last Update Date : 02/05/2022

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