Provider Demographics
NPI:1912284126
Name:GIANAN, EDMUND ARCILLA (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:ARCILLA
Last Name:GIANAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6330
Mailing Address - Country:US
Mailing Address - Phone:702-531-8006
Mailing Address - Fax:702-531-8013
Practice Address - Street 1:4470 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6330
Practice Address - Country:US
Practice Address - Phone:702-531-8006
Practice Address - Fax:702-531-8013
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist