Provider Demographics
NPI:1922535467
Name:PANG, NINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:PANG
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 1:8585 ELK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1774
Mailing Address - Country:US
Mailing Address - Phone:916-686-5193
Mailing Address - Fax:916-686-4553
Practice Address - Street 1:8585 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1774
Practice Address - Country:US
Practice Address - Phone:916-686-5193
Practice Address - Fax:916-686-4553
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist