Provider Demographics
NPI:1467085381
Name:CMH PHARMACY LLC
Entity Type:Organization
Organization Name:CMH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-400-3139
Mailing Address - Street 1:6445 W SUNSET RD STE 168
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3321
Mailing Address - Country:US
Mailing Address - Phone:725-780-1313
Mailing Address - Fax:725-780-1318
Practice Address - Street 1:6445 W SUNSET RD STE 168
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3321
Practice Address - Country:US
Practice Address - Phone:725-780-1313
Practice Address - Fax:725-780-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy