Provider Demographics
NPI:1326153529
Name:LIFECHEK MONTGOMERY LP
Entity Type:Organization
Organization Name:LIFECHEK MONTGOMERY LP
Other - Org Name:LIFECHEK 21
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRAINING AND DVLPMNT SPECIALST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-646-5119
Mailing Address - Street 1:1316 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-3531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2839
Practice Address - Country:US
Practice Address - Phone:903-893-5700
Practice Address - Fax:903-893-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17625333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144570Medicaid
4567307OtherOTHER ID NUMBER-COMMERCIAL NUMBER