Healthcare Provider Details

I. General information

NPI: 1104515386
Provider Name (Legal Business Name): ANDREI DABU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N BUFFALO DR STE 120
LAS VEGAS NV
89145-0309
US

IV. Provider business mailing address

321 N BUFFALO DR STE 120
LAS VEGAS NV
89145-0309
US

V. Phone/Fax

Practice location:
  • Phone: 702-909-4072
  • Fax:
Mailing address:
  • Phone: 702-909-4072
  • Fax: 702-909-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24501
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number195112
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: