Organization
WELL CARE PHARMACY I, LLC SERIES A
Active
Other names
Medtrans Behavioral Nevada Casal PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
ROYA BEUOKAGHAEI MANAGER (CREDENTIALING MANAGER)
(702) 410-7825
Entity
Organization
Contact information
Practice address
5446 BOULDER HWY STE G3, LAS VEGAS, NV 89122-6069
(702) 291-7121
Mailing address
3312 W CHARLESTON BLVD, LAS VEGAS, NV 89102-1829
(702) 410-7825
(702) 946-0409
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1835P1200X
Pharmacotherapy Pharmacist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
10/07/2015
Last updated
04/17/2024
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