NORTHEAST LAS VEGAS CBOC PHARM (4152)    INSTITUTION (4)

Name Value
NAME NORTHEAST LAS VEGAS CBOC PHARM
STATE NEVADA
STREET ADDR. 1 4461 E. CHARLESTON BLVD
CITY LAS VEGAS
ZIP 89104-5537
OFFICIAL VA NAME NORTHEAST LAS VEGAS CBOC PHARM
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME NORTHEAST LAS VEGAS CBOC PHARM
EFFECTIVE DATE/TIME
  • 2012-01-17 00:00:00
    STATUS:   ACTIVE
    NPI:   1386928992
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE PACIFIC
COUNTRY USA