Provider Demographics
NPI:1962781633
Name:APIBO-TANGO, ROBENSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBENSON
Middle Name:
Last Name:APIBO-TANGO
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:PO BOX 777833
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7833
Mailing Address - Country:US
Mailing Address - Phone:702-636-2054
Mailing Address - Fax:702-636-2028
Practice Address - Street 1:4090 W CRAIG RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2758
Practice Address - Country:US
Practice Address - Phone:702-636-2054
Practice Address - Fax:702-636-2028
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17611183500000X
AZS017675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist