Provider Demographics
NPI:1053866558
Name:ALI RAZA LLC
Entity Type:Organization
Organization Name:ALI RAZA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-816-4277
Mailing Address - Street 1:1131 E TROPICANA AVE # A-1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6601
Mailing Address - Country:US
Mailing Address - Phone:702-816-4277
Mailing Address - Fax:702-816-5469
Practice Address - Street 1:1131 E TROPICANA AVE # A-1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6601
Practice Address - Country:US
Practice Address - Phone:702-816-4277
Practice Address - Fax:702-816-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NVPH037043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166298OtherPK