MEDICARE: UHS RETAIL PHARMACY, 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
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy	PH03261	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2158007	OTHER		PK

General Provider Information

NPI Number	:	1700245560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UHS RETAIL PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2345 E PRATER WAY STE 111
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-9664
Country	:	US
Telephone Number	:	775-432-7907
Fax Number	:	775-343-0102

Provider Business Practice Location Address
First Line	:	2345 E PRATER WAY STE 111
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-9664
Country	:	US
Telephone Number	:	775-432-7907
Fax Number	:	775-343-0102

Authorized Official
Title or Position	:	CEO
Name	:	MARVIN PEMBER
Credential	:
Telephone Number	:	610-302-3300

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	01/23/2017

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