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General NPI Number Information
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NPI Number | 1477725398
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Entity Type | Organization
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Legal Business Name | LIFESPAN PHARMACY INC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 1341 W MOCKINGBIRD LN SUITE 304W
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City | DALLAS
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State | TX
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Zip | 75247
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Country | US
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Telephone | 214-220-0007
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Fax | 214-220-2850
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Provider Business Mailing Address
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Address Line | 1341 W MOCKINGBIRD LN SUITE 304W
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City | DALLAS
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State | TX
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Zip | 75247
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Country | US
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Telephone | 214-220-0007
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Fax | 214-220-2850
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Authorized Official
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Title or Position | OWNER/OFFICER
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Name | GINA RENNA
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Credential | PHARMACIST
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Telephone | 214-303-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 24217
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State | TX
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