Provider Demographics
NPI:1699377465
Name:SPINK, LISA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SPINK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11085 W. ROCKINGHORSE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:86445
Mailing Address - Country:US
Mailing Address - Phone:702-301-3723
Mailing Address - Fax:
Practice Address - Street 1:3075 E TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7311
Practice Address - Country:US
Practice Address - Phone:702-433-4834
Practice Address - Fax:702-433-4842
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist