MEDICARE: RITA CHANVISANURUK

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	183500000X	Pharmacist	16468	NV

General Provider Information

NPI Number	:	1760714091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA CHANVISANURUK

Provider Business Mailing Address
First Line	:	3760 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3760 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3233
Country	:	US
Telephone Number	:	702-458-4004
Fax Number	:	702-454-3053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	02/11/2010

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Directions to “ RITA CHANVISANURUK ” Practice Location

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