Indigo Pharmaceutical LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

INDIGO PHARMACEUTICAL LLC

Practice address

270 S Martin Luther King Blvd
Las Vegas, NV 89106-4305

Phone

(954) 557-0061

NPI assigned

Sep 14, 2022

Last updated

Sep 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eric Sparks, PHARMD

Title

Pharmacy Manager

Phone

(702) 427-0707

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1235851494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 S MARTIN LUTHER KING BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064305",
            "telephone_number": "954-557-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 S MARTIN LUTHER KING BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064305",
            "telephone_number": "954-557-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO PHARMACEUTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "702-427-0707",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Independent Life
• Independent Life LLC
• Sohum Indharapu
• Indian Springs Community Services
• Indiana Signal Health Receivable Management
• Indigo Supportive Services LLC.
• Indigo Wellness (Indigo Wellness Center)
• Indigo-Bane LLC (lo-go-pae-dics)
• Individual
• Individualized Internal Medicine

• Compounding Pharmacy in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Compounding Pharmacy in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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.