Provider Demographics
NPI:1639580905
Name:PINSKI, LISA (PHARM D)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PINSKI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 MIRA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7678
Mailing Address - Country:US
Mailing Address - Phone:530-672-8397
Mailing Address - Fax:
Practice Address - Street 1:3935 PARK DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4579
Practice Address - Country:US
Practice Address - Phone:916-933-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46104183500000X
WAPH 00018877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist