Provider Demographics
NPI:1427616747
Name:DIKUBA, PRINCELY-ROY NUNKA (RPH)
Entity type:Individual
Prefix:
First Name:PRINCELY-ROY
Middle Name:NUNKA
Last Name:DIKUBA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 HIGHWAY 180 E
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7781
Mailing Address - Country:US
Mailing Address - Phone:575-388-1909
Mailing Address - Fax:
Practice Address - Street 1:1956 HIGHWAY 180 E
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7781
Practice Address - Country:US
Practice Address - Phone:575-388-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist