Active NPI
Queennie Gan, RPH
- Pharmacist
- Las Vegas, NV
National Provider Identifier
1144679515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17771
- Practice address
- 201 N Nellis Blvd
Las Vegas, NV 89110-5321 - Phone
- (702) 452-8118
- NPI assigned
- Jun 7, 2016
- Last updated
- Jun 7, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17771 | NV | Primary |
Addresses
Primary practice location
201 N Nellis Blvd
Las Vegas, NV 89110-5321
Mailing address
PO Box 91852
Henderson, NV 89009-1852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17771 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465257600000",
"number": "1144679515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 91852",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890091852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 N NELLIS BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891105321",
"telephone_number": "702-452-8118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAN",
"first_name": "QUEENNIE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-07",
"last_updated": "2016-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "17771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.