Basic Information
| Provider Information | |||||||||
| NPI: | 1053952853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASAL | ||||||||
| FirstName: | MARCELINO | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024107825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 S WELLS AVE STE B | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753130530 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2019 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 13672 | NV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.