Organization
KDTK
Active
Other names
DOLCRX
Organization subpart
No
Provider details
NPI number
Authorized official
KHANH PHAM RPH (PHARMACY DIRECTOR & PIC)
(702) 436-5279
Entity
Organization
Contact information
Practice address
6820 W CHEYENNE AVE, LAS VEGAS, NV 89108-4590
(702) 436-5279
(702) 776-8201
Mailing address
6820 W CHEYENNE AVE, LAS VEGAS, NV 89108-4590
(702) 436-5279
(702) 776-8201
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH02657
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528368990
—
NV
01
—
2126219
PK
—
Enumeration date
11/01/2010
Last updated
01/15/2020
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