Provider Demographics
NPI:1306385877
Name:TANGO, INC
Entity Type:Organization
Organization Name:TANGO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:APIBO-TANGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-636-2054
Mailing Address - Street 1:PO BOX 777833
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7833
Mailing Address - Country:US
Mailing Address - Phone:702-636-2054
Mailing Address - Fax:
Practice Address - Street 1:4090 W CRAIG RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2758
Practice Address - Country:US
Practice Address - Phone:702-636-2054
Practice Address - Fax:702-636-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NVPH036893336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1306385877Medicaid
2168000OtherPK