MEDICARE: VILLAGE EAST DRUG

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	PH602	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2903296	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750442570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE EAST DRUG

Provider Business Mailing Address
First Line	:	2301 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4933
Country	:	US
Telephone Number	:	702-361-8800
Fax Number	:	702-361-6633

Provider Business Practice Location Address
First Line	:	2301 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4933
Country	:	US
Telephone Number	:	702-361-8800
Fax Number	:	702-361-6633

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD HORVATH
Credential	:	RPH
Telephone Number	:	702-361-8800

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/19/2008

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Directions to “VILLAGE EAST DRUG ” Practice Location

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