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NPI Code Detail

MEDICARE: ADMIX INFUSION PHARMACY, LLC

MEDICARE: ADMIX INFUSION PHARMACY, 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
1251F00000XHome Infusion AgencyPH03668NV
2333600000XPharmacyPH03668NV
33336C0003XCommunity/Retail PharmacyPH03668NV
43336C0004XCompounding PharmacyPH03668NV
53336S0011XSpecialty PharmacyPH03668NV
63336H0001XHome Infusion Therapy PharmacyPH03668NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PH03668OTHERNVNEVADA BOARD OF PHARMACY

General Provider Information

NPI Number : 1861938656
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADMIX INFUSION PHARMACY, LLC
Provider Business Mailing Address
First Line : 6725 S EASTERN AVE
Second Line : STE 8
City : LAS VEGAS
State : NV
Zip : 89119-3948
Country : US
Telephone Number : 702-852-2260
Fax Number : 702-852-2261
Provider Business Practice Location Address
First Line : 6725 S EASTERN AVE
Second Line : STE 8
City : LAS VEGAS
State : NV
Zip : 89119-3948
Country : US
Telephone Number : 702-852-2260
Fax Number : 702-852-2261
Authorized Official
Title or Position : PHARMACIST-IN-CHARGE / OWNER
Name : JAMES D PHIPPS
Credential : PHARMD
Telephone Number : 702-217-8748
Provider Enumeration Date : 01/17/2017
Last Update Date : 01/17/2017

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