Provider Demographics
NPI:1508452780
Name:VEGAS PHARMACY LLC
Entity Type:Organization
Organization Name:VEGAS PHARMACY LLC
Other - Org Name:VEGAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRADLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LENDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-410-5620
Mailing Address - Street 1:8352 W WARM SPRINGS RD STE 330
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3631
Mailing Address - Country:US
Mailing Address - Phone:702-410-5620
Mailing Address - Fax:702-444-4021
Practice Address - Street 1:8352 W WARM SPRINGS RD STE 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3631
Practice Address - Country:US
Practice Address - Phone:702-410-5620
Practice Address - Fax:702-444-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPHC04324OtherNV STATE BOARD OF PHARMACY LICENSE
NVPHC04324OtherNV STATE BOARD OF PHARMACY LICENSE