Provider Demographics
NPI:1316115413
Name:GETTYS CORP LLP
Entity type:Organization
Organization Name:GETTYS CORP LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST - RPH
Authorized Official - Phone:702-541-6023
Mailing Address - Street 1:2560 E SUNSET RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120
Mailing Address - Country:US
Mailing Address - Phone:702-541-6023
Mailing Address - Fax:702-405-8135
Practice Address - Street 1:2560 E SUNSET RD
Practice Address - Street 2:STE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-541-6023
Practice Address - Fax:702-405-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2013-04-05
Deactivation Date:2012-07-27
Deactivation Code:
Reactivation Date:2012-10-10
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336S0011X
NVPH025903336C0003X
NVPH023403336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2990794OtherNCPDP PROVIDER IDENTIFICATION NUMBER