Provider Demographics
NPI:1669038790
Name:HEMOSTASIS & THROMBOSIS CENTER OF NV PHARMACY
Entity Type:Organization
Organization Name:HEMOSTASIS & THROMBOSIS CENTER OF NV PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADULT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEDERIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-960-5712
Mailing Address - Street 1:8352 W WARM SPRINGS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3629
Mailing Address - Country:US
Mailing Address - Phone:702-960-5991
Mailing Address - Fax:702-832-1128
Practice Address - Street 1:8352 W WARM SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3629
Practice Address - Country:US
Practice Address - Phone:792-960-5991
Practice Address - Fax:702-832-1128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEMOSTASIS AND THROMBOSIS CENTER OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty