OrganizationActive
Nevada Family Practice Residence Program
NPI 1083683874 · Pharmacy · Las Vegas, NV
Provider details
- NPI number
- 1083683874
- Entity type
- Organization
- Primary specialty
- PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Kenneth Ryan, Pharmacist/Manager(702) 968-4038
- License
- PH1189 (NV)
Specialties & taxonomies
Suppliers
Practice location
4000 E Charleston Blvd
B-130
Las Vegas, NV 89104-6659
Phone: (702) 968-4038
Fax: (702) 968-4033
Approximate (ZIP-level) locationGet directions
Mailing address
4000 E Charleston Blvd
Las Vegas, NV 89104-6659
Other names (DBA / former)
- Other name
- Campus Pharmacy III
Registry dates
- Enumerated
- 2006-03-15
- Last updated
- 2010-10-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.