Provider Demographics
NPI:1770164840
Name:KHUMALO-MUSAH, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:KHUMALO-MUSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4916
Mailing Address - Country:US
Mailing Address - Phone:702-538-9388
Mailing Address - Fax:
Practice Address - Street 1:4845 S RAINBOW BLVD STE 403
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4750
Practice Address - Country:US
Practice Address - Phone:702-849-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist