1356882641 NPI number — REMEDIES PHARMACY INC

Table of content: (NPI 1356882641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356882641 NPI number — REMEDIES PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REMEDIES PHARMACY INC
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:
6
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:
1356882641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4180 S RAINBOW BLVD
Provider Second Line Business Mailing Address:
#808
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89103-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-722-3707
Provider Business Mailing Address Fax Number:
702-754-2548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4180 S RAINBOW BLVD
Provider Second Line Business Practice Location Address:
#808
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89103-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-722-3707
Provider Business Practice Location Address Fax Number:
702-754-2548
Provider Enumeration Date:
03/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MASHREKY
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-722-3707

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH03705 , 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: PH03705 . This is a "BOARD OF PHARMACY PERMIT" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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