Active NPI
Michael Phan
- Pharmacist
- Las Vegas, NV
National Provider Identifier
1346963121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20908
- Practice address
- 6391 W Lake Mead Blvd
Las Vegas, NV 89108-2646 - Phone
- (702) 631-7095
- NPI assigned
- Sep 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 | 20908 | NV | Primary |
Addresses
Primary practice location
6391 W Lake Mead Blvd
Las Vegas, NV 89108-2646
Mailing address
6391 W Lake Mead Blvd
Las Vegas, NV 89108-2646
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20908 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warm Springs Road CVS, L.L.C. | Past | Accepting new patients | |
| Warm Springs Road CVS LLC | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Henderson, NV
- NPI 1841212545
-
- Pharmacy
- Las Vegas, NV
- NPI 1669572004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1346963121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6391 W LAKE MEAD BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891082646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6391 W LAKE MEAD BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891082646",
"telephone_number": "702-631-7095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "20908",
"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 Sep 26, 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.