MEDICARE: NURO PHARMA INC

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	333600000X	Pharmacy	PH02872	NV

General Provider Information

NPI Number	:	1669725099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURO PHARMA INC

Provider Business Mailing Address
First Line	:	6380 POLARIS AVE UNIT B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3821
Country	:	US
Telephone Number	:	949-351-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 POLARIS AVE UNIT B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3821
Country	:	US
Telephone Number	:	949-351-6242
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES FARES
Credential	:
Telephone Number	:	702-269-1941

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	09/10/2013

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Directions to “NURO PHARMA INC ” Practice Location

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