Organization
MLK PHARMACY INC
Active
Other names
mlk pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SIMA MOGHADAM (OWNER)
(702) 272-2278
Entity
Organization
Contact information
Practice address
1100 N MARTIN L KING BLVD, LAS VEGAS, NV 89106-2853
(702) 272-2278
(702) 478-9043
Mailing address
1100 N MARTIN LUTHER KING BLVD, LAS VEGAS, NV 89106-2853
(702) 272-2278
(702) 478-9043
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02670
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2992471
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/02/2010
Last updated
04/09/2012
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