Provider Demographics
NPI:1508166331
Name:TYSDAL, LUKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:TYSDAL
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 1:820 S RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4825
Mailing Address - Country:US
Mailing Address - Phone:702-946-5333
Mailing Address - Fax:702-946-5339
Practice Address - Street 1:820 S RAMPART BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4825
Practice Address - Country:US
Practice Address - Phone:702-946-5333
Practice Address - Fax:702-946-5339
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist