Provider Demographics
NPI:1871314849
Name:CALLANTA, NICHOLAS AMIEL PANGANIBAN (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AMIEL PANGANIBAN
Last Name:CALLANTA
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 1:10374 CELESTIAL ECHO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4235
Mailing Address - Country:US
Mailing Address - Phone:702-769-9369
Mailing Address - Fax:
Practice Address - Street 1:618 MUSSER ST.
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:800-787-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88879183500000X
NV24027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist