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1063919991
MIRIAM FOMEN FANGA
LAS VEGAS, NV
NPI
1063919991
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
3336C0003X Pharmacy, Community/Retail Pharmacy
(Licence: NV 19831)
Enumeration Date
2018-04-08
Last Update Date
2018-06-16
Business Address
MIRIAM FOMEN FANGA
4895 BOULDER HWY # 100
LAS VEGAS, NV 89121-3086
Phone number: 702-898-5264
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Mailing Address
MIRIAM FOMEN FANGA
2180 E WARM SPRINGS RD UNIT 2163
LAS VEGAS, NV 89119-0449
Phone number: 240-462-1809
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