Provider Demographics
NPI:1124595558
Name:LIFE TREE PHARMACY SERVICES INCORPORATED
Entity Type:Organization
Organization Name:LIFE TREE PHARMACY SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGLIANETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-489-6640
Mailing Address - Street 1:5 BLUE HERON DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2057
Mailing Address - Country:US
Mailing Address - Phone:610-489-6640
Mailing Address - Fax:610-489-6645
Practice Address - Street 1:120 PARK CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-3605
Practice Address - Country:US
Practice Address - Phone:610-489-6640
Practice Address - Fax:610-489-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy