MEDICARE: NANIKO DIONNE LARRY PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S015430	AZ
2	183500000X	Pharmacist	17156	NV
3	183500000X	Pharmacist	051291714	IL

General Provider Information

NPI Number	:	1427367481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANIKO DIONNE LARRY PHARM.D.

Provider Business Mailing Address
First Line	:	4051 CATHEDRAL FALLS AVENUE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085
Country	:	US
Telephone Number	:	702-290-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	4051 CATHEDRAL FALLS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89085-4469
Country	:	US
Telephone Number	:	702-290-8199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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