Miriam Fomen Fanga

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

19831 Issued in NV

Practice address

4895 Boulder Hwy # 100
Las Vegas, NV 89121-3086

Phone

(702) 898-5264

NPI assigned

Apr 8, 2018

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1063919991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 E WARM SPRINGS RD UNIT 2163",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190449",
            "telephone_number": "240-462-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4895 BOULDER HWY # 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213086",
            "telephone_number": "702-898-5264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANGA",
        "first_name": "MIRIAM",
        "middle_name": "FOMEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-08",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NV",
            "license": "19831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST",
            "identifier": "19831",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jie Chan Fang
• Tongfei Fang
• William Fang, DO
• Xuan Zhao Fang
• Yao Min Fang
• Fani Foundation Organization Inc
• Emily Fankuleski, QBA
• Aisha Fanning
• Cara Fanning, MD
• Michelle P Fanning

• Community/Retail Pharmacy in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community/Retail Pharmacy in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.