Provider Demographics
NPI:1194140152
Name:A PHARMACY
Entity type:Organization
Organization Name:A PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AN
Authorized Official - Middle Name:THUC
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-646-1100
Mailing Address - Street 1:4592 SPRING MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8716
Mailing Address - Country:US
Mailing Address - Phone:702-646-1100
Mailing Address - Fax:702-646-1166
Practice Address - Street 1:4592 SPRING MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8716
Practice Address - Country:US
Practice Address - Phone:702-646-1100
Practice Address - Fax:702-646-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH023813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy