Organization
EZYFAST PHARMACY L L C
Active
Other names
EzyFast Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EZEKIEL KESITILWE (OWNER/MANAGER)
(928) 230-9812
Entity
Organization
Contact information
Practice address
1701 S CASINO DR, LAUGHLIN, NV 89029-1503
(702) 298-1701
(702) 298-1705
Mailing address
PO BOX 21238, BULLHEAD CITY, AZ 86439-1238
(928) 219-5912
(928) 219-5915
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH03236
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063825222
—
NV
01
—
2148529
PK
—
Enumeration date
06/05/2014
Last updated
01/17/2017
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