Provider Demographics
NPI:1871192229
Name:ADMASU, ANDUALEM
Entity Type:Individual
Prefix:
First Name:ANDUALEM
Middle Name:
Last Name:ADMASU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 W FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6414
Mailing Address - Country:US
Mailing Address - Phone:702-240-7055
Mailing Address - Fax:702-240-6682
Practice Address - Street 1:9350 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6414
Practice Address - Country:US
Practice Address - Phone:702-240-7055
Practice Address - Fax:702-240-6682
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist