Provider Demographics
NPI:1679635718
Name:ULTRACARE PHARMACY, INC
Entity Type:Organization
Organization Name:ULTRACARE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TIONGSON
Authorized Official - Last Name:BATUNGBACAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-597-0518
Mailing Address - Street 1:2545 CHANDLER AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4008
Mailing Address - Country:US
Mailing Address - Phone:702-597-0518
Mailing Address - Fax:702-597-0519
Practice Address - Street 1:2545 CHANDLER AVE STE 11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4008
Practice Address - Country:US
Practice Address - Phone:702-597-0518
Practice Address - Fax:702-597-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
NV332B00000X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies