Organization
LIFECARE PHARMACY, LLC
Active
Other names
Care N Home Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLETUS AMADI (PHARMACY MANAGER)
(702) 697-2105
Entity
Organization
Contact information
Practice address
3050 E DESERT INN RD, STE 124, LAS VEGAS, NV 89121-3870
(702) 697-2105
(702) 697-2107
Mailing address
3050 E DESERT INN RD, STE 124, LAS VEGAS, NV 89121-3870
(702) 697-2105
(702) 697-2107
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PH01798
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149104
PK
—
Enumeration date
12/04/2014
Last updated
12/04/2014
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