Dale Alphonso Atencio, PHARMD
Individual provider Active NPI Pharmacist · Las Vegas, NV
NPI 1497061733 · NPPES record last updated Nov 23, 2012
Key facts
- NPI
- 1497061733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 16051 (NV)
- Practice address
- 3717 Las Vegas Blvd S
Las Vegas, NV 89109-4384 - Phone
- (702) 262-0635
- Fax
- (702) 262-0896
- NPI assigned
- Aug 24, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00007008 | NM | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16051 | NV | Yes |
| Pharmacist | 183500000X | RP00007008 | NM |
Addresses
Primary practice location
3717 Las Vegas Blvd S
Las Vegas, NV 89109-4384
Mailing address
3717 Las Vegas Blvd S
Las Vegas, NV 89109-4384
Phone (702) 262-0635
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.