Healthcare Provider Details

I. General information

NPI: 1942270475
Provider Name (Legal Business Name): ELVANSON ROVINCER NANTONGO PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL BRANCH HEALTH CLINIC NAS FALLON BLDG 299 4755 PASTURE ROAD
FALLON NV
89496-5000
US

IV. Provider business mailing address

1204 E FRONT ST
FALLON NV
89406-6110
US

V. Phone/Fax

Practice location:
  • Phone: 775-426-3122
  • Fax:
Mailing address:
  • Phone: 775-426-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10098
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17564
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: