Provider Demographics
NPI:1053863605
Name:SOUTHERN NEVADA HEALTH DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN NEVADA HEALTH DISTRICT
Other - Org Name:SOUTHERN NEVADA HEALTH DISTRICT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION/AO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-759-0875
Mailing Address - Street 1:PO BOX 3902
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127
Mailing Address - Country:US
Mailing Address - Phone:702-759-1135
Mailing Address - Fax:
Practice Address - Street 1:280 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2936
Practice Address - Country:US
Practice Address - Phone:702-759-1135
Practice Address - Fax:702-759-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
NVPH035653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165974OtherPK