Active NPI
Karla Custodio
- Pharmacist
- Las Vegas, NV
National Provider Identifier
1568747269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17582
- Practice address
- 451 S Decatur Blvd
Las Vegas, NV 89107-2805 - Phone
- (702) 870-1626
- NPI assigned
- Oct 13, 2011
- Last updated
- Oct 13, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 17582 | NV | Primary |
Addresses
Primary practice location
451 S Decatur Blvd
Las Vegas, NV 89107-2805
Mailing address
112 Red Tee LN
Las Vegas, NV 89148-5262
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 |
|---|---|---|---|
| 17582 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318464000000",
"number": "1568747269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 RED TEE LN",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891485262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 S DECATUR BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891072805",
"telephone_number": "702-870-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTODIO",
"first_name": "KARLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-13",
"last_updated": "2011-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "17582",
"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 Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.