Josephine Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JOSEPHINE PHARMACY, LLC

Practice address

2013 E Charleston Blvd
Las Vegas, NV 89104-2056

Phone

(702) 403-1118

Fax

(702) 403-1108

NPI assigned

Jun 2, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Obiageli Lisa Momodu, PHARMDNPI 1538598651

Title

Managing Pharmacist

Phone

(702) 480-6221

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Obiageli Momodu

  • Pharmacist
  • Las Vegas, NV
  • NPI 1538598651
  NPD Authorized official
• Brandy Sha Smith

  • Pharmacist
  • Las Vegas, NV
  • NPI 1225855174
  NPD
• Maribel Simon-Cruz

  • Pharmacist
  • Las Vegas, NV
  • NPI 1023856473
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1003500158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 COTTONTAIL COVE ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891301352",
            "telephone_number": "702-480-6221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891042056",
            "telephone_number": "702-403-1118",
            "fax_number": "702-403-1108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPHINE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-02",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "MOMODU",
        "authorized_official_first_name": "OBIAGELI",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "MANAGING PHARMACIST",
        "authorized_official_telephone_number": "702-480-6221",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250026014",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saju Joseph, MD
• Samantha D Joseph
• Shana Mariya Joseph, RBT
• Toyin Joseph, LPN
• Yousef Joseph, DO
• Josephs House LLC
• Adam Josephs
• Kayla Josephson
• Kismet Josey, PTA
• Avni Joshi

• Community/Retail Pharmacy in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community/Retail Pharmacy in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.