Provider Demographics
NPI:1639940505
Name:NEVADA SPECIALTY PHARMACY
Entity type:Organization
Organization Name:NEVADA SPECIALTY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-826-7234
Mailing Address - Street 1:556 N EASTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3453
Mailing Address - Country:US
Mailing Address - Phone:702-356-8493
Mailing Address - Fax:702-356-8907
Practice Address - Street 1:556 N EASTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3453
Practice Address - Country:US
Practice Address - Phone:702-356-8493
Practice Address - Fax:702-356-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy