Provider Demographics
NPI:1417205048
Name:DEVONICK, LISA ANN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:DEVONICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 BLACK CINDER CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-7020
Mailing Address - Country:US
Mailing Address - Phone:407-284-0568
Mailing Address - Fax:
Practice Address - Street 1:3000 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6702
Practice Address - Country:US
Practice Address - Phone:775-359-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist