1033434022 NPI number — NEVADA DRUG COMPOUNDING PHARMACY EAST

Table of content: (NPI 1033434022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033434022 NPI number — NEVADA DRUG COMPOUNDING PHARMACY EAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA DRUG COMPOUNDING PHARMACY EAST
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:
Provider Other Organization Name Type Code:
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:
1033434022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3041 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-3948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-293-6900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3041 W HORIZON RIDGE PKWY
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-293-6900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TRUITT
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
702-564-2079

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH01713 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: PH01713 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com