SOUTHEAST LAS VEGAS CBOC PHARM (4124)    INSTITUTION (4)

Name Value
NAME SOUTHEAST LAS VEGAS CBOC PHARM
STATE NEVADA
STREET ADDR. 1 1020 S. BOULDER HIGHWAY
CITY HENDERSON
ZIP 89015-8533
OFFICIAL VA NAME SOUTHEAST LAS VEGAS CBOC PHARM
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME SOUTHEAST LAS VEGAS VA CBOC PHARM
EFFECTIVE DATE/TIME
  • 2011-11-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1033493408
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE PACIFIC
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA