Provider Demographics
NPI:1467717892
Name:LIFEMED PHARMACY LLC
Entity Type:Organization
Organization Name:LIFEMED PHARMACY LLC
Other - Org Name:LIFEMED PHARMACY OF ROCHESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-350-3446
Mailing Address - Street 1:4577 N NOB HILL RAAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:847-350-3446
Mailing Address - Fax:954-748-1170
Practice Address - Street 1:1249 RIDGEWAY AVE STE Q
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3761
Practice Address - Country:US
Practice Address - Phone:847-350-3446
Practice Address - Fax:954-748-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0315043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136176OtherPK