Provider Demographics
NPI:1982619573
Name:CEDAR PHARMACY
Entity type:Organization
Organization Name:CEDAR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM D, MANAGER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-436-0016
Mailing Address - Street 1:8955 S PECOS RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7157
Mailing Address - Country:US
Mailing Address - Phone:702-436-0016
Mailing Address - Fax:702-269-1654
Practice Address - Street 1:8955 S PECOS RD STE 1B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7157
Practice Address - Country:US
Practice Address - Phone:702-436-0016
Practice Address - Fax:702-269-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH02068333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507390Medicaid
2989272OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2989272OtherOTHER ID NUMBER-COMMERCIAL NUMBER