Provider Demographics
NPI:1841545530
Name:LAPUZ, IVY HAZELL LEGARDA
Entity type:Individual
Prefix:
First Name:IVY HAZELL
Middle Name:LEGARDA
Last Name:LAPUZ
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 1:6360 E SAHARA AVE
Mailing Address - Street 2:APT 2066
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-2855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6360 E SAHARA AVE
Practice Address - Street 2:APT 2066
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-2855
Practice Address - Country:US
Practice Address - Phone:702-472-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV560107010216794183700000X
NVPT12498183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician