MEDICARE: EUCYT LABORATORIES, L.L.C.

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	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1679193106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUCYT LABORATORIES, L.L.C.

Provider Business Mailing Address
First Line	:	5670 WYNN RD STE D&E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2356
Country	:	US
Telephone Number	:	702-776-4114
Fax Number	:	702-909-3757

Provider Business Practice Location Address
First Line	:	5670 WYNN RD STE D&E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2356
Country	:	US
Telephone Number	:	702-776-4114
Fax Number	:	702-909-3757

Authorized Official
Title or Position	:	CFO
Name	:	AARON COATS
Credential	:
Telephone Number	:	651-468-1171

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	11/13/2020

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