NPIMap

Organization Active NPI

Nevada Family Practice Residence Program

  • Pharmacy
  • Las Vegas, NV
National Provider Identifier
1083683874
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PH1189 Issued in NV
Legal business name
NEVADA FAMILY PRACTICE RESIDENCE PROGRAM
Practice address
4000 E Charleston Blvd
B-130
Las Vegas, NV 89104-6659
Phone
(702) 968-4038
Fax
(702) 968-4033
NPI assigned
Mar 15, 2006
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Mr. Kenneth J. Ryan, RPH
Title
Pharmacist/Manager
Phone
(702) 968-4038

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PH1189 NV Primary

Addresses

Primary practice location

4000 E Charleston Blvd
B-130
Las Vegas, NV 89104-6659

Mailing address

4000 E Charleston Blvd
B-130
Las Vegas, NV 89104-6659
Phone (702) 968-4038

Other names 1

  • Campus Pharmacy III Other name

National Provider Directory

National Provider Directory
Tax ID family
NV Family Practice Resi5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4000 E Charleston Blvd
#B130
Las Vegas, NV 89104
Phone (702) 968-4000

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1083683874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 E CHARLESTON BLVD",
            "address_2": "B-130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891046659",
            "telephone_number": "702-968-4038",
            "fax_number": "702-968-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 E CHARLESTON BLVD",
            "address_2": "B-130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891046659",
            "telephone_number": "702-968-4038",
            "fax_number": "702-968-4033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA FAMILY PRACTICE RESIDENCE PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PHARMACIST/MANAGER",
        "authorized_official_telephone_number": "702-968-4038",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NV",
            "license": "PH1189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campus Pharmacy III",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.