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NPI Code Detail

MEDICARE: GRACE OPULENCIA RPH

MEDICARE: GRACE OPULENCIA RPH
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
1183500000XPharmacist15190NV

General Provider Information

NPI Number : 1881977429
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE OPULENCIA RPH
Provider Business Mailing Address
First Line : 2389 E WINDMILL LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2037
Country : US
Telephone Number : 702-837-9531
Fax Number : 702-837-9561
Provider Business Practice Location Address
First Line : 2389 E WINDMILL LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2037
Country : US
Telephone Number : 702-837-9531
Fax Number : 702-837-9561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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Directions to “ GRACE OPULENCIA RPH” Practice Location

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