Provider Demographics
NPI:1740044262
Name:ALBANA, BON RIWILIN ANTIPORTA (PHARMD)
Entity type:Individual
Prefix:
First Name:BON RIWILIN
Middle Name:ANTIPORTA
Last Name:ALBANA
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 1:6178 MEADOWGRASS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1118
Mailing Address - Country:US
Mailing Address - Phone:702-882-5651
Mailing Address - Fax:
Practice Address - Street 1:2667 WINDMILL PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3384
Practice Address - Country:US
Practice Address - Phone:702-361-1157
Practice Address - Fax:702-361-0642
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist