Organization
EMERALD LAKE, INC
Active
Other names
emerald medical supply
Organization subpart
No
Provider details
NPI number
Authorized official
MARCEL EZEOKE RPH (MANAGER)
(702) 678-6776
Entity
Organization
Contact information
Practice address
500 S MARTIN L KING BLVD STE D, LAS VEGAS, NV 89106-4424
(702) 678-6776
(702) 678-6661
Mailing address
500 S MARTIN L KING BLVD STE D, LAS VEGAS, NV 89106-4424
(702) 678-6776
(702) 678-6661
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NV
Other
Enumeration date
05/01/2007
Last updated
08/22/2020
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