Provider Demographics
NPI:1497914162
Name:SNAMHS DOWNTOWN PHARMACY
Entity Type:Organization
Organization Name:SNAMHS DOWNTOWN PHARMACY
Other - Org Name:SNAMHS DOWNTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OBIDIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEANACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-668-4702
Mailing Address - Street 1:720 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6932
Practice Address - Country:US
Practice Address - Phone:702-668-4700
Practice Address - Fax:702-668-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH022683336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002802008NMedicaid
2991063OtherOTHER ID NUMBER