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NPI Code Detail

MEDICARE: AMANDA RAROGAL NICOLAS

MEDICARE: AMANDA RAROGAL NICOLAS
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
1183500000XPharmacist60467165WA
2183500000XPharmacist18987NV
3183500000XPharmacist3847HI

General Provider Information

NPI Number : 1871995738
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RAROGAL NICOLAS
Provider Business Mailing Address
First Line : 2011 E LAKE MEAD BLVD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7135
Country : US
Telephone Number : 702-642-9780
Fax Number :
Provider Business Practice Location Address
First Line : 2011 E LAKE MEAD BLVD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7135
Country : US
Telephone Number : 702-642-9780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 07/08/2015

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Directions to “ AMANDA RAROGAL NICOLAS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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