MEDICARE: KENNETH M TO R. PH.

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	15166	NV

General Provider Information

NPI Number	:	1891078531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH M TO R. PH.

Provider Business Mailing Address
First Line	:	8350 BRIOVA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2257
Country	:	US
Telephone Number	:	855-427-4682
Fax Number	:	877-342-4596

Provider Business Practice Location Address
First Line	:	8350 BRIOVA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2257
Country	:	US
Telephone Number	:	855-427-4682
Fax Number	:	877-432-4596

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	01/26/2019

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