Provider Demographics
NPI:1275957136
Name:PAC LP
Entity Type:Organization
Organization Name:PAC LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:BASHIR
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-610-6353
Mailing Address - Street 1:PO BOX 401721
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-1721
Mailing Address - Country:US
Mailing Address - Phone:800-610-6353
Mailing Address - Fax:
Practice Address - Street 1:9465 W POST ROAD
Practice Address - Street 2:SUITE 1068
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5786
Practice Address - Country:US
Practice Address - Phone:562-587-6862
Practice Address - Fax:866-645-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site