Provider Demographics
NPI:1770905440
Name:PCPLV LLC
Entity type:Organization
Organization Name:PCPLV LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-203-8526
Mailing Address - Street 1:4445 S EASTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7851
Mailing Address - Country:US
Mailing Address - Phone:702-203-8526
Mailing Address - Fax:
Practice Address - Street 1:4445 S EASTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7851
Practice Address - Country:US
Practice Address - Phone:702-203-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy