Organization
BLACK PANDA LLC
Active
Other names
Aeva Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA DEINET (MANAGING MEMBER)
(702) 219-6173
Entity
Organization
Contact information
Practice address
2507 S STATE ST, SALT LAKE CITY, UT 84115-3109
(855) 558-2382
Mailing address
6280 S VALLEY VIEW BLVD STE 734, LAS VEGAS, NV 89118-6833
(702) 219-6173
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Enumeration date
08/03/2020
Last updated
08/03/2020
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