Provider Demographics
NPI:1447310487
Name:UNLV STUDENT HEALTH PHARMACY
Entity type:Organization
Organization Name:UNLV STUDENT HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:GOLIA
Authorized Official - Last Name:HARTIG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-895-0278
Mailing Address - Street 1:4505 S MARYLAND PKWY
Mailing Address - Street 2:BOX 453020
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89154-9900
Mailing Address - Country:US
Mailing Address - Phone:702-895-0278
Mailing Address - Fax:702-895-0698
Practice Address - Street 1:4505 S MARYLAND PKWY
Practice Address - Street 2:BOX 453020
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89154-9900
Practice Address - Country:US
Practice Address - Phone:702-895-0278
Practice Address - Fax:702-895-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH00950261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBS4224301OtherDEA