Provider Demographics
NPI:1508264979
Name:UHS RETAIL PHARMACY LLC
Entity Type:Organization
Organization Name:UHS RETAIL PHARMACY LLC
Other - Org Name:CENTRX PHARMACY NORTHERN NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:BSC PHARMACY
Authorized Official - Phone:610-302-3300
Mailing Address - Street 1:2345 E PRATER WAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9600
Mailing Address - Country:US
Mailing Address - Phone:941-350-0665
Mailing Address - Fax:
Practice Address - Street 1:2345 E PRATER WAY STE 111
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9664
Practice Address - Country:US
Practice Address - Phone:775-432-7907
Practice Address - Fax:775-343-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH032613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1508264979Medicaid
2149668OtherPK