Organization
DIVINE PROVIDENCE INC
Active
Other names
Providence Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MODUPE IROROBEJE (CHIEF PHARMACIST)
(702) 778-3072
Entity
Organization
Contact information
Practice address
1729 E CHARLESTON BLVD STE F, LAS VEGAS, NV 89104-1986
(702) 778-3072
(702) 778-0512
Mailing address
1729 E CHARLESTON BLVD STE F, LAS VEGAS, NV 89104-1986
(702) 778-3072
(702) 778-0512
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH03196
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154733905
—
NV
01
—
2147176
PK
—
Enumeration date
05/28/2014
Last updated
09/21/2016
Update your record
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