Provider Demographics
NPI:1033974126
Name:NU-LIFERX
Entity Type:Organization
Organization Name:NU-LIFERX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, DPH
Authorized Official - Phone:423-328-3446
Mailing Address - Street 1:1374 WEAVER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-3716
Mailing Address - Country:US
Mailing Address - Phone:276-298-9157
Mailing Address - Fax:
Practice Address - Street 1:880 BOONES STATION RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4402
Practice Address - Country:US
Practice Address - Phone:423-328-3446
Practice Address - Fax:423-328-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy