Individual
DAT CAO DO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
110 CRICKLEWOOD AVE, HENDERSON, NV 89002-9287
(702) 292-9647
Mailing address
110 CRICKLEWOOD AVE, HENDERSON, NV 89002-9287
(702) 292-9647
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17657
NV
183500000X
Pharmacist
63802
CA
Other
Enumeration date
04/20/2012
Last updated
04/20/2012
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