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NPI Code Detail

MEDICARE: PROCARE PHARMACY LLC

MEDICARE: PROCARE 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
13336C0003XCommunity/Retail PharmacyPH02774NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12992887OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1962773135
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROCARE PHARMACY LLC
Provider Business Mailing Address
First Line : 6870 S RAINBOW BLVD
Second Line : SUITE 106
City : LAS VEGAS
State : NV
Zip : 89118-2106
Country : US
Telephone Number : 702-207-7777
Fax Number : 702-207-0644
Provider Business Practice Location Address
First Line : 6870 S RAINBOW BLVD
Second Line : SUITE 106
City : LAS VEGAS
State : NV
Zip : 89118-2106
Country : US
Telephone Number : 702-207-7777
Fax Number : 702-207-0644
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : THAI VO
Credential :
Telephone Number : 702-426-6414
Provider Enumeration Date : 01/20/2012
Last Update Date : 03/29/2012

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Directions to “PROCARE PHARMACY LLC ” Practice Location

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