Provider Demographics
NPI:1033434022
Name:NEVADA DRUG COMPOUNDING PHARMACY EAST
Entity Type:Organization
Organization Name:NEVADA DRUG COMPOUNDING PHARMACY EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-564-2079
Mailing Address - Street 1:3041 W HORIZON RIDGE PKWY
Mailing Address - Street 2:#100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3948
Mailing Address - Country:US
Mailing Address - Phone:702-293-6900
Mailing Address - Fax:
Practice Address - Street 1:3041 W HORIZON RIDGE PKWY
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3948
Practice Address - Country:US
Practice Address - Phone:702-293-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FVS HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH017133336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy