Provider Demographics
NPI:1942270475
Name:NANTONGO, ELVANSON ROVINCER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELVANSON
Middle Name:ROVINCER
Last Name:NANTONGO
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 1:1204 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6110
Mailing Address - Country:US
Mailing Address - Phone:775-426-8431
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC NAS FALLON BLDG 299
Practice Address - Street 2:4755 PASTURE ROAD
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496-5000
Practice Address - Country:US
Practice Address - Phone:775-426-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10098183500000X
NV17564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist