Provider Demographics
NPI:1871117739
Name:MYLYFE LLC
Entity type:Organization
Organization Name:MYLYFE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-314-6098
Mailing Address - Street 1:1111 ELM ST STE 12
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1540
Mailing Address - Country:US
Mailing Address - Phone:844-469-5933
Mailing Address - Fax:
Practice Address - Street 1:1111 ELM ST STE 12
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1540
Practice Address - Country:US
Practice Address - Phone:844-469-5933
Practice Address - Fax:844-469-5933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOMATRIX SPECIALTY PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-05
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110162120AMedicaid