Provider Demographics
NPI:1255679395
Name:EDOUARD, NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N GREEN VALLEY PKWY STE 814
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0409
Mailing Address - Country:US
Mailing Address - Phone:833-834-2779
Mailing Address - Fax:833-834-2780
Practice Address - Street 1:2920 N GREEN VALLEY PKWY STE 814
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0409
Practice Address - Country:US
Practice Address - Phone:833-834-2779
Practice Address - Fax:833-834-2780
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1841786415OtherLVSRX NPI