Provider Demographics
NPI:1518527431
Name:BAM HEALTHCARE LVIC LLC
Entity Type:Organization
Organization Name:BAM HEALTHCARE LVIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-732-1818
Mailing Address - Street 1:8930 W SUNSET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5009
Mailing Address - Country:US
Mailing Address - Phone:702-747-3007
Mailing Address - Fax:702-747-3163
Practice Address - Street 1:8930 W SUNSET RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5009
Practice Address - Country:US
Practice Address - Phone:702-747-3007
Practice Address - Fax:702-747-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPH04062OtherBOP NEVADA
NVPH04062OtherBOP NEVADA