Provider Demographics
NPI:1497027403
Name:NACULANGGA, ROSALIE ESPENO (RPH)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:ESPENO
Last Name:NACULANGGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 MALLARD WAY
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-8404
Mailing Address - Country:US
Mailing Address - Phone:775-980-9880
Mailing Address - Fax:
Practice Address - Street 1:805 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9743
Practice Address - Country:US
Practice Address - Phone:775-575-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist