Provider Demographics
NPI:1427367481
Name:LARRY, NANIKO DIONNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANIKO
Middle Name:DIONNE
Last Name:LARRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 CATHEDRAL FALLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085
Mailing Address - Country:US
Mailing Address - Phone:702-290-8199
Mailing Address - Fax:
Practice Address - Street 1:4051 CATHEDRAL FALLS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4469
Practice Address - Country:US
Practice Address - Phone:702-290-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015430183500000X
NV17156183500000X
IL051291714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist