Divine Providence Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH03196 Issued in NV

Legal business name

DIVINE PROVIDENCE INC

Practice address

1729 E Charleston Blvd Ste F
Las Vegas, NV 89104-1986

Phone

(702) 778-3072

Fax

(702) 778-0512

NPI assigned

May 28, 2014

Organization subpart

No

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

Authorized official

Name

Modupe IrorobejeNPI 1184405953

Title

Chief Pharmacist

Phone

(702) 778-3072

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Providence Pharmacy Doing business as

Locations

Practitioners 1

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

• Modupe Irorobeje, PHARMD

  • Pharmacist
  • Las Vegas, NV
  • NPI 1184405953
  NPD Authorized official

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

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1154733905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 E CHARLESTON BLVD STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041986",
            "telephone_number": "702-778-3072",
            "fax_number": "702-778-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 E CHARLESTON BLVD STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041986",
            "telephone_number": "702-778-3072",
            "fax_number": "702-778-0512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PROVIDENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-28",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "IROROBEJE",
        "authorized_official_first_name": "MODUPE",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "702-778-3072"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NV",
            "license": "PH03196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154733905",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147176",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Divine Healthcare Solutions LLC
• Divine Hospice LLC
• Divine Instructions Behavioral Health Services, LLC
• Divine Mercy Health Services LLC
• Divine Mobility & Comfort, Inc
• Divine Providence Inc
• Divine Soul Mental Health Pierre-Louis PLLC
• Divine Touch Services Pharmacy & Compounding
• Divine Wellness Las Vegas
• Tyler Divis

• 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 21, 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.

Verify at the official NPI Registry.