Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miriam Fomen Fanga

Individual provider Community/Retail Pharmacy · NPI 1063919991

Miriam Fomen Fanga is a Community/Retail Pharmacy in Las Vegas, Nevada. Practices as a sole proprietor. Licensed in Nevada.

Licensed in
NV
In the registry since
2018

Practice location Address checks out

4895 Boulder Hwy # 100
Las Vegas, NV 89121-3086
Phone: (702) 898-5264
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence 19831 (NV)

Record details

NPI number1063919991
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedApril 8, 2018
Last updated in NPPESJune 16, 2018

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