Provider Demographics
NPI:1053858480
Name:ACRX SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:ACRX SPECIALTY PHARMACY
Other - Org Name:ACRX SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EGHOMWARE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBINOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-800-6448
Mailing Address - Street 1:3200 SOARING GULLS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2198
Mailing Address - Country:US
Mailing Address - Phone:702-800-6448
Mailing Address - Fax:
Practice Address - Street 1:3200 SOARING GULLS DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2198
Practice Address - Country:US
Practice Address - Phone:702-800-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 333600000X, 3336H0001X, 3336L0003X, 3336S0011X
NVPH036733336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167202OtherPK