Provider Demographics
NPI:1750987871
Name:ENRIQUEZ, ROSALIE ARENDELA
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:ARENDELA
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 VILLA VASARI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0453
Mailing Address - Country:US
Mailing Address - Phone:702-400-5625
Mailing Address - Fax:
Practice Address - Street 1:8116 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1015
Practice Address - Country:US
Practice Address - Phone:702-407-7063
Practice Address - Fax:702-407-7086
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist