MEDICARE: MA LOURDES JAMILLA JAUREGUI 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
1	183500000X	Pharmacist	17035	NV

General Provider Information

NPI Number	:	1962092676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA LOURDES JAMILLA JAUREGUI RPH

Provider Business Mailing Address
First Line	:	2797 S MARYLAND PKWY STE 28
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1576
Country	:	US
Telephone Number	:	702-776-8210
Fax Number	:	702-776-7195

Provider Business Practice Location Address
First Line	:	2797 S MARYLAND PKWY STE 28
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1576
Country	:	US
Telephone Number	:	702-776-8210
Fax Number	:	702-776-7195

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

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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