Provider Demographics
NPI:1689267692
Name:BLUE FALCON LLC
Entity Type:Organization
Organization Name:BLUE FALCON LLC
Other - Org Name:RIGHT DOSE PHARMCAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UGONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NNODIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-209-3640
Mailing Address - Street 1:2505 ANTHEM VILLAGE DR STE E282
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5505
Mailing Address - Country:US
Mailing Address - Phone:702-209-3640
Mailing Address - Fax:702-209-3641
Practice Address - Street 1:1235 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1708
Practice Address - Country:US
Practice Address - Phone:702-209-3640
Practice Address - Fax:702-209-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250013030Medicaid