Individual provider Active NPI

Ugonna Nnodim, PHARM D

  • Pharmacist
  • Las Vegas, NV
National Provider Identifier
1699042135
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP00007764 Issued in NM
Practice address
1235 E Charleston Blvd
Las Vegas, NV 89104-1708
Phone
(702) 209-3640
Fax
(702) 209-3641
NPI assigned
Nov 29, 2011
Last updated
May 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP00007764 NM Primary

Addresses

Primary practice location

1235 E Charleston Blvd
Las Vegas, NV 89104-1708

Mailing address

1235 E Charleston Blvd
Las Vegas, NV 89104-1708
Phone (702) 209-3640

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RP00007764NMMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Falcon LLC CurrentSince May 25, 2021 Accepting new patients

Locations

1235 E Charleston Blvd
Las Vegas, NV 89104
Phone (702) 209-3640

Organizations & group practices 1

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": "1322524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1699042135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041708",
            "telephone_number": "702-209-3640",
            "fax_number": "702-209-3641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891041708",
            "telephone_number": "702-209-3640",
            "fax_number": "702-209-3641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NNODIM",
        "first_name": "UGONNA",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-29",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "RP00007764",
            "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 May 18, 2021; 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.