Provider Demographics
NPI:1699100495
Name:KOROGHLI, JOSHUA ANTHONY (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANTHONY
Last Name:KOROGHLI
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 S EASTERN AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5485
Mailing Address - Country:US
Mailing Address - Phone:702-333-4377
Mailing Address - Fax:
Practice Address - Street 1:3808 E TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6021
Practice Address - Country:US
Practice Address - Phone:702-547-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist