Provider Demographics
NPI:1184035487
Name:WELL CARE PHARMACY I, LLC
Entity Type:Organization
Organization Name:WELL CARE PHARMACY I, LLC
Other - Org Name:MCCARRAN PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-468-6355
Mailing Address - Street 1:4101 WAGON TRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4426
Mailing Address - Country:US
Mailing Address - Phone:702-946-0353
Mailing Address - Fax:702-946-0353
Practice Address - Street 1:5757 WAYNE NEWTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89111-8037
Practice Address - Country:US
Practice Address - Phone:702-576-9545
Practice Address - Fax:702-946-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH031643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy