MEDICARE: PHOENIX PHARMACEUTICALS INC

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH02973	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141053	OTHER		PK

General Provider Information

NPI Number	:	1992145965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PHARMACEUTICALS INC

Provider Business Mailing Address
First Line	:	6096 S FORT APACHE RD # 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5585
Country	:	US
Telephone Number	:	702-685-1233
Fax Number	:	702-724-9070

Provider Business Practice Location Address
First Line	:	6096 S FORT APACHE RD # 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5585
Country	:	US
Telephone Number	:	702-685-1233
Fax Number	:	702-724-9070

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	JASMINE TA
Credential	:
Telephone Number	:	702-685-1233

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	10/24/2014

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Directions to “PHOENIX PHARMACEUTICALS INC ” Practice Location

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