Organization
FIDELIS HEALTH GROUP LLC
Active
Other names
Fidelis Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WAGNER A LEMUS (PRESIDENT)
(702) 815-0800
Entity
Organization
Contact information
Practice address
5275 ARVILLE ST STE 156, LAS VEGAS, NV 89118-4937
(702) 815-0800
(702) 815-0801
Mailing address
5275 ARVILLE ST STE 156, LAS VEGAS, NV 89118-4937
(702) 815-0800
(702) 815-0801
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
PH03042
NV
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255761128
—
NV
Enumeration date
11/13/2013
Last updated
09/20/2018
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