Provider Demographics
NPI:1720097041
Name:MULU CHOKELE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MULU CHOKELE PROFESSIONAL CORPORATION
Other - Org Name:TIME PHARMACY AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MULU
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOKELE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:702-383-9069
Mailing Address - Street 1:150 E HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-4533
Mailing Address - Country:US
Mailing Address - Phone:702-383-9069
Mailing Address - Fax:902-383-9116
Practice Address - Street 1:150 E HARMON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-4533
Practice Address - Country:US
Practice Address - Phone:702-383-9069
Practice Address - Fax:902-383-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH02060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty