Provider Demographics
NPI:1649058116
Name:JESIEL, CARTER REESE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARTER
Middle Name:REESE
Last Name:JESIEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:CARTER
Other - Middle Name:
Other - Last Name:JESIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8883 OREANA PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1385
Mailing Address - Country:US
Mailing Address - Phone:702-786-2170
Mailing Address - Fax:
Practice Address - Street 1:7350 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-0400
Practice Address - Country:US
Practice Address - Phone:702-739-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist