Provider Demographics
NPI:1316416993
Name:KOLICCI, ORNELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ORNELA
Middle Name:
Last Name:KOLICCI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 EXCEL LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3757
Mailing Address - Country:US
Mailing Address - Phone:702-408-4415
Mailing Address - Fax:
Practice Address - Street 1:6401 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1118
Practice Address - Country:US
Practice Address - Phone:702-259-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist