Provider Demographics
NPI:1376069609
Name:LIFETIME PHARMACY LLC
Entity Type:Organization
Organization Name:LIFETIME PHARMACY LLC
Other - Org Name:LIFETIME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANIL KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPETI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-491-5599
Mailing Address - Street 1:960 RIDGEVIEW DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:214-491-5599
Mailing Address - Fax:888-363-5386
Practice Address - Street 1:960 RIDGEVIEW DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:214-491-5599
Practice Address - Fax:888-363-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy