Provider Demographics
NPI:1164147476
Name:REVOLINSKI, JOHN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:REVOLINSKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 MANCHA DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3613
Mailing Address - Country:US
Mailing Address - Phone:213-300-2438
Mailing Address - Fax:
Practice Address - Street 1:1521 MANCHA DR
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-3613
Practice Address - Country:US
Practice Address - Phone:213-300-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist