Provider Demographics
NPI:1316287014
Name:LASARSO, MATTHEW G (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:LASARSO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E MIDDLETON DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8027
Mailing Address - Country:US
Mailing Address - Phone:702-792-3777
Mailing Address - Fax:702-792-1171
Practice Address - Street 1:8579 S EASTERN AVE
Practice Address - Street 2:STE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2887
Practice Address - Country:US
Practice Address - Phone:702-792-3777
Practice Address - Fax:702-792-1171
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist