Provider Demographics
NPI:1366539561
Name:MEDCO HEALTH SOLUTIONS OF HENDERSON LLC
Entity type:Organization
Organization Name:MEDCO HEALTH SOLUTIONS OF HENDERSON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-269-6900
Mailing Address - Street 1:100 PARSONS POND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 N STEPHANIE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6676
Practice Address - Country:US
Practice Address - Phone:702-547-7100
Practice Address - Fax:702-547-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH1435333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2975184OtherOTHER ID NUMBER-COMMERCIAL NUMBER