Provider Demographics
NPI:1003361999
Name:GRANDE, THOMAS ENRICO (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ENRICO
Last Name:GRANDE
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 1:8660 S MILLER LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5323
Mailing Address - Country:US
Mailing Address - Phone:702-871-2590
Mailing Address - Fax:
Practice Address - Street 1:8579 S EASTERN AVE
Practice Address - Street 2:SUITE 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:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist