Provider Demographics
NPI:1386398220
Name:DADJA, ARSEN
Entity type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:DADJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 N DURANGO DR STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4596
Mailing Address - Country:US
Mailing Address - Phone:702-470-2694
Mailing Address - Fax:
Practice Address - Street 1:6850 N DURANGO DR STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4596
Practice Address - Country:US
Practice Address - Phone:702-470-2694
Practice Address - Fax:702-641-5612
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist