MLK Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH02670 Issued in NV

Legal business name

MLK PHARMACY INC

Practice address

1100 N Martin L King Blvd
Las Vegas, NV 89106-2853

Phone

(702) 272-2278

Fax

(702) 478-9043

NPI assigned

Nov 2, 2010

Organization subpart

No

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

Authorized official

Name

Sima Moghadam

Title

Owner

Phone

(702) 272-2278

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• mlk pharmacy Doing business as

Locations

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

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1285934588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N MARTIN LUTHER KING BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891062853",
            "telephone_number": "702-272-2278",
            "fax_number": "702-478-9043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N MARTIN L KING BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891062853",
            "telephone_number": "702-272-2278",
            "fax_number": "702-478-9043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-02",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "MOGHADAM",
        "authorized_official_first_name": "SIMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-272-2278"
    },
    "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": "PH02670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2992471",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "mlk pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Apr 9, 2012; 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.