Provider Demographics
NPI:1255741195
Name:MWANGI, NELSON M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:M
Last Name:MWANGI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 FANCREST ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2330
Mailing Address - Country:US
Mailing Address - Phone:702-325-7872
Mailing Address - Fax:
Practice Address - Street 1:276 FANCREST ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2330
Practice Address - Country:US
Practice Address - Phone:702-325-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV163111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV16311OtherNEVADA BOARD OF PHARMACY