Provider Demographics
NPI:1497976468
Name:VONGPANYA, ADELINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADELINA
Middle Name:
Last Name:VONGPANYA
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 1:7100 ARROYO CROSSING PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4057
Mailing Address - Country:US
Mailing Address - Phone:702-260-6264
Mailing Address - Fax:702-260-6411
Practice Address - Street 1:7100 ARROYO CROSSING PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4057
Practice Address - Country:US
Practice Address - Phone:702-260-6264
Practice Address - Fax:702-260-6411
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist