MIRIAM FOMEN FANGA (NPI# 1063919991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063919991 |
Entity Type | Individual |
Full Name | MIRIAM FOMEN FANGA |
Practice Address |
4895 Boulder Hwy # 100 Las Vegas NV 89121-3086 |
Mailing Address |
2180 E Warm Springs Rd Unit 2163 Las Vegas NV 89119-0449 |
Practice Telephone | 7028985264 |
Mailing Telephone | 2404621809 |
Enumeration Date | 2018-04-08 |
Last Update Date | 2018-06-16 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
19831 | NV | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NV | PHARMACIST | 19831 | 01 |
Street Address |
4895 BOULDER HWY # 100 |
City | LAS VEGAS |
State | NV |
Zip Code | 89121-3086 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598379117 | Western State Behavioral Health and Psychiatric Services | Psychologist | 3910 Pecos-mcleod Interconnect, Las Vegas, NV 89121 | 2020-09-01 |
1962025155 | Arieste Diaz Perez | Clinic/Center | 3777 Pecos-mcleod Interconnect, Suite 101, Las Vegas, NV 89121 | 2020-05-21 |
1366071904 | Vanesa Silva | Behavior Technician | 4714 Flamigo Rd, Las Vegas, NV 89121 | 2020-04-06 |
1053955732 | Valente Solis Santiago | Technician | 2785 E. Desert Inn Rd Ste. 240, Las Vegas, NV 89121 | 2019-11-05 |
1750938981 | Ken Ernst | Rehabilitation Practitioner | Primary Solutions Medical Billing, 4525 S. Sandhill Rd Ste #112, Las Vegas, NV 89121 | 2019-08-22 |
1902450455 | Tracey Anora Henry | Counselor | 3675 Pecos Mecleod Ste 900, Las Vegas, NV 89121 | 2019-08-01 |
1679127096 | Wilma Guadalupe Nunez | Chore Provider | 2860 East Flamingo, Suite C, Las Vegas, NV 89121 | 2019-07-25 |
1487213807 | Karla Susana Ayala | Chore Provider | 2860 E. Flamingo Rd Ste K., Las Vegas, NV 89121 | 2019-06-10 |
1447819164 | Jovita Garcia-perez | Chore Provider | 2860 E. Flamingo Suite C, Suite C, Las Vegas, NV 89121 | 2019-06-06 |
1164081972 | Maria Isabel Castellanos Gonzalez | Chore Provider | 2860 E. Flamingo Rd Ste K, Las Vegas, NV 89121 | 2019-06-06 |
Find all providers in zip 89121 |
Taxonomy Code | 3336C0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Community/Retail Pharmacy |
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205442928 | Plus One Pharmacy, LLC | Pharmacy | 6545 S Fort Apache Rd Ste 140, Las Vegas, NV 89148-6758 | 2020-09-17 |
1790308880 | Capsule Las Vegas LLC | Pharmacy | 801 S Rancho Dr Ste A4, Las Vegas, NV 89106-3870 | 2020-05-22 |
1417596511 | Caremark L.L.C. | Pharmacy | 7251 S Eastern Ave, Las Vegas, NV 89119-4507 | 2020-01-06 |
1609411610 | Credo Pharmacy LLC | Pharmacy | 8995 W Flamingo Rd Ste 120, Las Vegas, NV 89147-0441 | 2019-11-13 |
1629637129 | Modern Rx | Pharmacy | 6330 S Eastern Ave Ste 1a, Las Vegas, NV 89119-3168 | 2019-06-07 |
1750947677 | Southwest Specialty Pharmacy LLC | Pharmacy | 8170 S Eastern Ave Ste 10, Las Vegas, NV 89123-2578 | 2019-05-16 |
1447728373 | Goodwill Pharmacy Inc | Pharmacy | 6725 S Eastern Ave Ste 7, Las Vegas, NV 89119-3949 | 2018-11-08 |
1699240697 | Silver State Pharmacy LLC | Pharmacy | 1591 N Buffalo Dr Ste 140, Las Vegas, NV 89128-3632 | 2018-10-05 |
1275019770 | Guadalupe Pharmacy Inc. | Pharmacy | 3827 E Sunset Rd Ste L, Las Vegas, NV 89120-3900 | 2018-07-17 |
1629569892 | Sahara Limited Group LLC. | Pharmacy | 6125 W Sahara Ave Ste 1a, Las Vegas, NV 89146-3002 | 2018-05-23 |
Find all providers in LAS VEGAS |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.