Provider Demographics
NPI:1508525957
Name:WAYNEFARGO ICARE LLC
Entity Type:Organization
Organization Name:WAYNEFARGO ICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINHQUANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-321-2593
Mailing Address - Street 1:5595 SPRING MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8863
Mailing Address - Country:US
Mailing Address - Phone:702-478-8551
Mailing Address - Fax:
Practice Address - Street 1:5595 SPRING MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8863
Practice Address - Country:US
Practice Address - Phone:702-478-8551
Practice Address - Fax:702-478-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy