Provider Demographics
NPI:1164175519
Name:MEDTRUST PHARMACY LLC
Entity type:Organization
Organization Name:MEDTRUST PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:NOURELDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-331-3414
Mailing Address - Street 1:3375 E RUSSELL RD # 1G
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3472
Mailing Address - Country:US
Mailing Address - Phone:702-331-3414
Mailing Address - Fax:702-331-3413
Practice Address - Street 1:3375 E RUSSELL RD # 1G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3472
Practice Address - Country:US
Practice Address - Phone:702-331-3414
Practice Address - Fax:702-331-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy