Provider Demographics
NPI:1114200532
Name:GILLASPIE, CARY JOE (RPH)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:JOE
Last Name:GILLASPIE
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 1:611 MALL RING CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6619
Mailing Address - Country:US
Mailing Address - Phone:702-433-0144
Mailing Address - Fax:702-433-3856
Practice Address - Street 1:611 MALL RING CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6619
Practice Address - Country:US
Practice Address - Phone:702-433-0144
Practice Address - Fax:702-433-3856
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist