LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC (NPI# 1962648261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962648261 |
| Entity Type | Organization |
| Organization Name | LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC |
| Practice Address |
6225 Annie Oakley Dr Suite 100 Las Vegas NV 89120-3914 |
| Mailing Address |
8881 Liberty Ln Attn;compliance Port St Lucie FL 34952-3477 |
| Practice Telephone | 8004913276 |
| Practice Fax Number | 8775928466 |
| Mailing Telephone | 7723985800 |
| Mailing Fax Number | 7723982192 |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2012-12-05 |
| Authorized Official Name | MR. KEITH JONES (PRESIDENT, DIRECTOR) |
| Authorized Official Telephone | 7723985800 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIBERTY HEALTHCARE GROUP, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336M0002X |
Pharmacy Specialization: Mail Order Pharmacy |
PH02204 | NV | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | RESIDENT PHARMACY LICENSE | PH02204 | 01 |
| NCPDP | 2991520 | 01 | |
| FEDERAL DEA | FL0048543 | 01 |
| Street Address |
6225 ANNIE OAKLEY DR SUITE 100 |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89120-3914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891833471 | Edgar Lee Raglin | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2007-02-03 |
| 1629478078 | Ronald V Gerardo | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2014-09-03 |
| 1043592389 | Jane Johnston | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2011-09-13 |
| 1093935926 | David E Moredock | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2007-04-25 |
| 1528287273 | Gary Stephen Bodnar | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2007-04-24 |
| 1740405463 | James Peter Bianca | Pharmacist | 6225 Annie Oakley Dr, Las Vegas, NV 89120-3914 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447850144 | Mental Edge Therapy Professional LLC | Psychologist | 2520 St. Rose Parkway, Suite 220-a (219), Las Vegas, NV 89120 | 2020-10-30 |
| 1740896877 | Global Behavior Analyst | Behavioral Analyst | 2510 East Sunset Rd, Ste 5 Pmb 670, Las Vegas, NV 89120 | 2020-09-23 |
| 1225656804 | Michael Y Chang Md PC | Anesthesiology | 2700 Sunset Rd B18, Las Vegas, NV 89120 | 2020-07-09 |
| 1053962142 | Arlene M Mcmillen | Technician | 3321 Casey Drive, Apt 104 Bldg 15, Las Vegas, NV 89120 | 2019-09-20 |
| 1942858634 | Michael A Fortunato Md Pllc | Anesthesiology | Michael A Fortunato, Md Pllc, 2700 Sunset Rd #b18, Las Vegas, NV 89120 | 2019-08-27 |
| 1023664521 | Christine White | Behavior Technician | 8431 Sunset Road, Suite 110, Henderson, NV 89120 | 2019-08-12 |
| 1922653435 | David Stefon Mayo | Technician | 3960 E. Patrick Lane, Suite 202., Las Vegas, NV 89120 | 2019-08-02 |
| 1346893724 | Joseph Acuna | Technician | 3960 E. Patrick Lane, Suite 202, Las Vegas, NV 89120 | 2019-07-24 |
| 1588217582 | Va Natasha Manutai | Technician | 3980 E Patrick Lane, Suite 202, Las Vegas, NV 89120 | 2019-07-18 |
| 1811557788 | Fidencia Gutierrez | Chore Provider | 2690 Chandler Ave. Ste. 1, Ste. 1, Las Vegas, NV 89120 | 2019-06-13 |
| Find all providers in zip 89120 | ||||
| Taxonomy Code | 3336M0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Mail Order Pharmacy |
| A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477109981 | Safe Pharmacy | Pharmacy | 5410 Cameron St Ste 102, Las Vegas, NV 89118-2249 | 2019-08-12 |
| 1962693234 | Pharmix Center, LLC | Pharmacy | 2560 E Sunset Rd, Suite 120, Las Vegas, NV 89120-3516 | 2007-08-02 |
Please comment or provide details below to improve the information on LIBERTY HEALTHCARE PHARMACY OF NEVADA LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.