Provider Demographics
NPI:1407467418
Name:MALLARI, NOELLE D (RPH)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:D
Last Name:MALLARI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 N BUFFALO DR UNIT 1117
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4811
Mailing Address - Country:US
Mailing Address - Phone:725-400-2721
Mailing Address - Fax:
Practice Address - Street 1:6401 W CHARLESTON BLVD # 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:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist