Provider Demographics
NPI:1225394109
Name:LIFE PHARMACY CORP.
Entity Type:Organization
Organization Name:LIFE PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:787-818-5433
Mailing Address - Street 1:815 CALLE CONCEPCION VERA
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-818-5433
Mailing Address - Fax:
Practice Address - Street 1:CARR. 110 KM 11.2 BO. PUEBLO
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4877333600000X
PR19-F-34973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy