NPI 1154733905 · live from the CMS NPI Registry
Divine Providence INC
Pharmacy, Community/Retail Pharmacy in Las Vegas, NV. National Provider Identifier 1154733905, active.
NPI record
| NPI | 1154733905 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 1729 E Charleston Blvd Ste F, Las Vegas, NV 89104 |
| Practice phone | 702-778-3072 |
| Enumerated | May 28, 2014 |
| Last updated | September 21, 2016 |
| Authorized official | Modupe Irorobeje, Chief Pharmacist |
| Other names | Providence Pharmacy |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pharmacy | 333600000X | — |
| Pharmacy, Community/Retail Pharmacy primary | 3336C0003X | PH03196 (NV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.