Provider Demographics
NPI:1245056381
Name:FAMILY MEDICAL PHARMACY, LLC
Entity type:Organization
Organization Name:FAMILY MEDICAL PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:VILLALUZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:312-545-3805
Mailing Address - Street 1:1825 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7113
Mailing Address - Country:US
Mailing Address - Phone:312-545-3805
Mailing Address - Fax:725-258-8757
Practice Address - Street 1:1825 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7113
Practice Address - Country:US
Practice Address - Phone:312-545-3805
Practice Address - Fax:725-258-8757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY MEDICAL PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy