Provider Demographics
NPI:1104218825
Name:UHS RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:UHS RETAIL PHARMACY LLC
Other - Org Name:CENTRX PHARMACY DESERT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARMACY
Authorized Official - Phone:610-302-3300
Mailing Address - Street 1:2075 E FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5188
Mailing Address - Country:US
Mailing Address - Phone:469-243-0164
Mailing Address - Fax:
Practice Address - Street 1:2075 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5188
Practice Address - Country:US
Practice Address - Phone:702-425-4939
Practice Address - Fax:775-624-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH033163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104218825Medicaid
2151233OtherPK