Provider Demographics
NPI:1134250814
Name:LAS VEGAS PHARMACY, INC.
Entity type:Organization
Organization Name:LAS VEGAS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTALE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-220-3906
Mailing Address - Street 1:5470 W SAHARA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3307
Mailing Address - Country:US
Mailing Address - Phone:702-220-3906
Mailing Address - Fax:702-220-3919
Practice Address - Street 1:5470 W SAHARA AVE # B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3307
Practice Address - Country:US
Practice Address - Phone:702-220-3906
Practice Address - Fax:702-220-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH02163333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy