Healthcare Provider Details

I. General information

NPI: 1235825803
Provider Name (Legal Business Name): JOSEPH DANGIDANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SR-160 E
PAHRUMP NV
89048
US

IV. Provider business mailing address

5630 ALFANO AVE
PAHRUMP NV
89061-7032
US

V. Phone/Fax

Practice location:
  • Phone: 702-787-7319
  • Fax:
Mailing address:
  • Phone: 702-787-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23476
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: