MEDICARE: EARLMATTHEW PEREGRINO RPH, 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
1	183500000X	Pharmacist	23299	NV

General Provider Information

NPI Number	:	1821709791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARLMATTHEW PEREGRINO RPH, PHARMD

Provider Business Mailing Address
First Line	:	4845 S FORT APACHE RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7956
Country	:	US
Telephone Number	:	775-762-2359
Fax Number	:

Provider Business Practice Location Address
First Line	:	4845 S FORT APACHE RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7956
Country	:	US
Telephone Number	:	702-992-3668
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	09/17/2024

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