Provider Demographics
NPI:1548925845
Name:ATLAS HEALTHCARE
Entity type:Organization
Organization Name:ATLAS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:OBIDIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEANACHO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-580-9863
Mailing Address - Street 1:3585 S MARYLAND PKWY STE J
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3031
Mailing Address - Country:US
Mailing Address - Phone:702-580-9863
Mailing Address - Fax:725-205-4926
Practice Address - Street 1:3585 S MARYLAND PKWY STE J
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3031
Practice Address - Country:US
Practice Address - Phone:702-580-9863
Practice Address - Fax:725-205-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPH04382OtherNVBOP