Individual
LACIE TAKETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4470 E BONANZA RD, LAS VEGAS, NV 89110-6330
(800) 627-3999
Mailing address
4470 E BONANZA RD, LAS VEGAS, NV 89110-6330
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
20359
NV
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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