Provider Demographics
NPI:1164018610
Name:LIFEFIRST PHARMACY LLC
Entity Type:Organization
Organization Name:LIFEFIRST PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-500-3580
Mailing Address - Street 1:315 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1805
Mailing Address - Country:US
Mailing Address - Phone:973-500-3580
Mailing Address - Fax:973-500-3579
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1805
Practice Address - Country:US
Practice Address - Phone:973-500-3580
Practice Address - Fax:973-500-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0868426Medicaid