Organization
LIFESPAN PHARMACY INC
Active
Other names
LIFESPAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GINA RENNA PHARMACIST (OWNER/OFFICER)
(214) 303-1888
Entity
Organization
Contact information
Practice address
1341 W MOCKINGBIRD LN, SUITE 304W, DALLAS, TX 75247
(214) 220-0007
(214) 220-2850
Mailing address
1341 W MOCKINGBIRD LN, SUITE 304W, DALLAS, TX 75247
(214) 220-0007
(214) 220-2850
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
TX
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
24217
TX
3336S0011X
Specialty Pharmacy
Primary
—
TX
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4525688
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/01/2008
Last updated
08/16/2018
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