| NPI | 1154733905 |
|---|---|
| Doing Business As | PROVIDENCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MODUPE IROROBEJE Chief Pharmacist 702-778-3072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NV PH03196) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2016-09-21 |