Provider Demographics
NPI:1447440250
Name:LIFEMED PHARMACY LLC
Entity type:Organization
Organization Name:LIFEMED PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-350-3446
Mailing Address - Street 1:4577 N NOB HILL RD
Mailing Address - Street 2:#209
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4712
Mailing Address - Country:US
Mailing Address - Phone:847-350-3446
Mailing Address - Fax:954-748-1170
Practice Address - Street 1:447 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1345
Practice Address - Country:US
Practice Address - Phone:847-350-3446
Practice Address - Fax:954-748-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284853336L0003X
CT00009833336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2907904Medicaid
2069494OtherPK