Provider Demographics
NPI:1770867699
Name:EGBASE, FELIX (RPH)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:EGBASE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 VULCAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3463
Mailing Address - Country:US
Mailing Address - Phone:702-510-3531
Mailing Address - Fax:866-438-7771
Practice Address - Street 1:4006 VULCAN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3463
Practice Address - Country:US
Practice Address - Phone:702-510-3531
Practice Address - Fax:866-438-7771
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist