Provider Demographics
NPI:1831683655
Name:TANGO, INC
Entity type:Organization
Organization Name:TANGO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:APIBO-TANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-636-2054
Mailing Address - Street 1:PO BOX 777833
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7833
Mailing Address - Country:US
Mailing Address - Phone:702-636-2054
Mailing Address - Fax:702-636-2028
Practice Address - Street 1:4090 W CRAIG RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2758
Practice Address - Country:US
Practice Address - Phone:702-636-2054
Practice Address - Fax:702-636-2028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANGO, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy