Organization
EMERALD LAKE, I NC
Active
Other names
EMERALD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCEL C EZEOKE R.PH (MANAGER)
(702) 678-6776
Entity
Organization
Contact information
Practice address
500 S MARTIN L KING BLVD STE D, LAS VEGAS, NV 89106-4424
(702) 678-6776
(702) 678-6661
Mailing address
500 S MARTIN L KING BLVD STE D, LAS VEGAS, NV 89106-4424
(702) 678-6776
(702) 678-6661
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH01612
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2802694
—
NV
Enumeration date
02/12/2007
Last updated
08/22/2020
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