Organization
JOSEPHINE PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OBIAGELI LISA MOMODU PHARMD (MANAGING PHARMACIST)
(702) 480-6221
Entity
Organization
Contact information
Practice address
2013 E CHARLESTON BLVD, LAS VEGAS, NV 89104-2056
(702) 403-1118
(702) 403-1108
Mailing address
6013 COTTONTAIL COVE ST, LAS VEGAS, NV 89130-1352
(702) 480-6221
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250026014
—
NV
Enumeration date
06/02/2023
Last updated
09/12/2023
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