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NPI Code Detail

MEDICARE: DR. LIDYA DERBSA PHARMD

MEDICARE: DR. LIDYA DERBSA PHARMD
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
1183500000XPharmacist20637NV

General Provider Information

NPI Number : 1750977815
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LIDYA DERBSA PHARMD
Provider Business Mailing Address
First Line : 475 E WINDMILL LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1808
Country : US
Telephone Number : 792-896-7414
Fax Number :
Provider Business Practice Location Address
First Line : 475 E WINDMILL LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-1808
Country : US
Telephone Number : 792-896-7414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2020
Last Update Date : 12/14/2020

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Directions to “ DR. LIDYA DERBSA PHARMD” Practice Location

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