Provider Demographics
NPI:1639479165
Name:ADVANCED CARE RX PHARMACY 1, LLC
Entity Type:Organization
Organization Name:ADVANCED CARE RX PHARMACY 1, LLC
Other - Org Name:QHR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOLIH
Authorized Official - Middle Name:OJONG
Authorized Official - Last Name:OROCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-331-6796
Mailing Address - Street 1:7512 WESTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5175
Mailing Address - Country:US
Mailing Address - Phone:702-331-6796
Mailing Address - Fax:702-629-7130
Practice Address - Street 1:7512 WESTCLIFF DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5175
Practice Address - Country:US
Practice Address - Phone:702-331-6796
Practice Address - Fax:702-629-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH026563336C0003X, 3336C0004X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1639479165Medicaid