Provider Demographics
NPI:1518407741
Name:LAS VEGAS MEDICAL STORE
Entity Type:Organization
Organization Name:LAS VEGAS MEDICAL STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMENAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-601-4622
Mailing Address - Street 1:4523 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3760
Mailing Address - Country:US
Mailing Address - Phone:702-803-1365
Mailing Address - Fax:
Practice Address - Street 1:4523 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3760
Practice Address - Country:US
Practice Address - Phone:702-803-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies