Provider Demographics
NPI:1992301378
Name:AGBADJE, ALAIN JUDICAEL, MOULERO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALAIN
Middle Name:JUDICAEL, MOULERO
Last Name:AGBADJE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 TERTULIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6761
Mailing Address - Country:US
Mailing Address - Phone:702-917-1026
Mailing Address - Fax:
Practice Address - Street 1:1980 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1217
Practice Address - Country:US
Practice Address - Phone:775-882-2299
Practice Address - Fax:775-882-2705
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist