Provider Demographics
NPI:1548894397
Name:PINNACLE ABSOLUTE CARE LLC
Entity type:Organization
Organization Name:PINNACLE ABSOLUTE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KODJOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-241-9653
Mailing Address - Street 1:2815 W LAKE MEAD BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4900
Mailing Address - Country:US
Mailing Address - Phone:702-847-6675
Mailing Address - Fax:702-847-6656
Practice Address - Street 1:2815 W LAKE MEAD BLVD STE 109
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4900
Practice Address - Country:US
Practice Address - Phone:702-847-6675
Practice Address - Fax:702-847-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1548894397Medicaid