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NPI Code Detail

MEDICARE: M PHARMACY LLC

MEDICARE: M 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
13336C0003XCommunity/Retail PharmacyPH02472NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12991556OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1710125091
Entity Type Code : Organization
Provider Name (Legal Business Name) : M PHARMACY LLC
Provider Business Mailing Address
First Line : 12300 LAS VEGAS BLVD S
Second Line :
City : HENDERSON
State : NV
Zip : 89044-9506
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12300 LAS VEGAS BLVD S
Second Line :
City : HENDERSON
State : NV
Zip : 89044-9506
Country : US
Telephone Number : 702-797-1900
Fax Number : 702-797-1901
Authorized Official
Title or Position : MANAGER
Name : DAVID VASENDEN
Credential : RPH
Telephone Number : 775-772-1185
Provider Enumeration Date : 01/26/2009
Last Update Date : 03/09/2009

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Directions to “M PHARMACY LLC ” Practice Location

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