Provider Demographics
NPI:1619215936
Name:PAHRUMP VALLEY PHARMACY, LLC
Entity Type:Organization
Organization Name:PAHRUMP VALLEY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:775-727-1200
Mailing Address - Street 1:1266 E CALVADA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-8221
Mailing Address - Country:US
Mailing Address - Phone:775-727-1200
Mailing Address - Fax:775-727-1203
Practice Address - Street 1:1266 E CALVADA BLVD STE 2
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-8221
Practice Address - Country:US
Practice Address - Phone:775-727-1200
Practice Address - Fax:775-727-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6852110001Medicare NSC