Provider Demographics
NPI:1750688388
Name:ADVANCED CARE RX PHARMACY 2 LLC
Entity Type:Organization
Organization Name:ADVANCED CARE RX PHARMACY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EGHOMWARE
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:IGBINOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-595-6265
Mailing Address - Street 1:4161 S EASTERN AVE
Mailing Address - Street 2:A-3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5484
Mailing Address - Country:US
Mailing Address - Phone:702-331-0284
Mailing Address - Fax:702-331-0291
Practice Address - Street 1:4161 S EASTERN AVE
Practice Address - Street 2:A-3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5484
Practice Address - Country:US
Practice Address - Phone:702-331-0284
Practice Address - Fax:702-331-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy