Provider Demographics
NPI:1720683576
Name:MADRIAGA, ALEC JANSEN CARANDANG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEC JANSEN
Middle Name:CARANDANG
Last Name:MADRIAGA
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 1:6701 DEL REY AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9215
Mailing Address - Country:US
Mailing Address - Phone:702-418-9517
Mailing Address - Fax:
Practice Address - Street 1:2011 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7135
Practice Address - Country:US
Practice Address - Phone:702-649-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist