Provider Demographics
NPI:1972223113
Name:VELASCO, JEOFFREY
Entity Type:Individual
Prefix:
First Name:JEOFFREY
Middle Name:
Last Name:VELASCO
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 1:401 N ARROYO GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3974
Mailing Address - Country:US
Mailing Address - Phone:702-436-7106
Mailing Address - Fax:
Practice Address - Street 1:401 N ARROYO GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3974
Practice Address - Country:US
Practice Address - Phone:702-436-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist