Provider Demographics
NPI:1629681051
Name:SEGOVIA, ZICXLABETH (RPH)
Entity Type:Individual
Prefix:
First Name:ZICXLABETH
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 BRIGHTON VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-7101
Mailing Address - Country:US
Mailing Address - Phone:928-208-0096
Mailing Address - Fax:
Practice Address - Street 1:8500 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7262
Practice Address - Country:US
Practice Address - Phone:702-655-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist