Organization
STATE OF NEVADA
Active
Other names
SOUTHERN NEVADA ADULT MENTAL HEALTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES COSTAS (STATEWIDE PHARMACY DIRECTOR)
(702) 486-6301
Entity
Organization
Contact information
Practice address
1590 W SUNSET RD, HENDERSON, NV 89014-6633
(702) 486-6860
(702) 486-6862
Mailing address
1590 W SUNSET RD, HENDERSON, NV 89014-6633
(702) 486-6860
(702) 486-6862
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PH01180
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2052188
PK
—
Enumeration date
12/11/2008
Last updated
07/13/2016
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