Provider Demographics
NPI:1447581913
Name:ADVANCED CARE RX PHARMACY
Entity Type:Organization
Organization Name:ADVANCED CARE RX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EGHE
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:IGBINOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:702-595-6265
Mailing Address - Street 1:840 E TWAIN AVE STE 137
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4025
Mailing Address - Country:US
Mailing Address - Phone:702-272-2709
Mailing Address - Fax:702-405-0673
Practice Address - Street 1:840 E TWAIN AVE STE 137
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4025
Practice Address - Country:US
Practice Address - Phone:702-272-2709
Practice Address - Fax:702-405-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH025833336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy