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NPI Code Detail

MEDICARE: ADVANCED CARE RX PHARMACY 2 LLC

MEDICARE: ADVANCED CARE RX PHARMACY 2 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
13336C0004XCompounding Pharmacy
23336S0011XSpecialty Pharmacy
33336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1750688388
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED CARE RX PHARMACY 2 LLC
Provider Business Mailing Address
First Line : 4161 S EASTERN AVE
Second Line : A-3
City : LAS VEGAS
State : NV
Zip : 89119-5484
Country : US
Telephone Number : 702-331-0284
Fax Number : 702-331-0291
Provider Business Practice Location Address
First Line : 4161 S EASTERN AVE
Second Line : A-3
City : LAS VEGAS
State : NV
Zip : 89119-5484
Country : US
Telephone Number : 702-331-0284
Fax Number : 702-331-0291
Authorized Official
Title or Position : MANAGING OFFICER
Name : EGHOMWARE JERRY IGBINOVIA
Credential :
Telephone Number : 702-595-6265
Provider Enumeration Date : 02/16/2011
Last Update Date : 02/16/2011

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Directions to “ADVANCED CARE RX PHARMACY 2 LLC ” Practice Location

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