Healthcare Provider Details

I. General information

NPI: 1497027403
Provider Name (Legal Business Name): ROSALIE ESPENO NACULANGGA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E MAIN ST
FERNLEY NV
89408-9743
US

IV. Provider business mailing address

477 MALLARD WAY
FERNLEY NV
89408-8404
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-4435
  • Fax:
Mailing address:
  • Phone: 775-980-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17989
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: