Provider Demographics
NPI:1588237531
Name:IGLINSKI, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:IGLINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 SUMMIT SIERRA BLVD UNIT 2109
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-9334
Mailing Address - Country:US
Mailing Address - Phone:802-733-5296
Mailing Address - Fax:
Practice Address - Street 1:1342 US HIGHWAY 395 N
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5309
Practice Address - Country:US
Practice Address - Phone:775-782-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist