Provider Demographics
NPI:1306122825
Name:NETARDUS, DEBBIE L (RPH)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:L
Last Name:NETARDUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:NETARDUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3480 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6709
Mailing Address - Country:US
Mailing Address - Phone:702-871-1405
Mailing Address - Fax:702-871-1657
Practice Address - Street 1:3480 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6709
Practice Address - Country:US
Practice Address - Phone:702-871-1405
Practice Address - Fax:702-871-1657
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13513183500000X
TX36437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist