# BLACK PANDA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aeva Specialty Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518577741
- **Authorized official:** BARBARA DEINET (MANAGING MEMBER)
- **Authorized official phone:** (702) 219-6173

## Contact information

- **Practice address:** 2507 S STATE ST, SALT LAKE CITY, UT 84115-3109
- **Practice address phone:** (855) 558-2382
- **Mailing address:** 6280 S VALLEY VIEW BLVD STE 734, LAS VEGAS, NV 89118-6833
- **Mailing address phone:** (702) 219-6173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/03/2020
- **Last updated:** 08/03/2020