Provider Demographics
NPI:1003417361
Name:ALSMAEL, DEFAF
Entity Type:Individual
Prefix:
First Name:DEFAF
Middle Name:
Last Name:ALSMAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 INDIGO SKY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2193
Mailing Address - Country:US
Mailing Address - Phone:702-628-6768
Mailing Address - Fax:
Practice Address - Street 1:6570 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-7044
Practice Address - Country:US
Practice Address - Phone:702-437-6441
Practice Address - Fax:702-437-3590
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist