Provider Demographics
NPI:1700208089
Name:AEVA LLC
Entity Type:Organization
Organization Name:AEVA LLC
Other - Org Name:AEVA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEINET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-558-2382
Mailing Address - Street 1:6280 S VALLEY VIEW BLVD STE 732
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6833
Mailing Address - Country:US
Mailing Address - Phone:702-558-2382
Mailing Address - Fax:702-558-5407
Practice Address - Street 1:6280 S VALLEY VIEW BLVD STE 732
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6833
Practice Address - Country:US
Practice Address - Phone:702-558-2382
Practice Address - Fax:702-558-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy