1881085140 NPI number — UHS RETAIL PHARMACY LLC

Table of content: (NPI 1881085140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881085140 NPI number — UHS RETAIL PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UHS RETAIL PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRX PHARMACY SUMMERLIN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881085140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
653 N TOWN CENTER DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89144-0515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-578-1583
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N TOWN CENTER DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89144-0515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-432-7907
Provider Business Practice Location Address Fax Number:
214-451-6110
Provider Enumeration Date:
02/09/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEMBER
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
610-302-3300

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH03290 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881085140 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2150425 . This is a "PK" identifier . This identifiers is of the category "OTHER".