Provider Demographics
NPI:1699166652
Name:UHS RETAIL PHARMACY LLC
Entity type:Organization
Organization Name:UHS RETAIL PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARMACY
Authorized Official - Phone:610-302-3300
Mailing Address - Street 1:6850 N DURANGO DR STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4596
Mailing Address - Country:US
Mailing Address - Phone:702-470-2694
Mailing Address - Fax:214-451-6110
Practice Address - Street 1:6850 N DURANGO DR STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-470-2694
Practice Address - Fax:214-451-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH032893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150423OtherPK