Provider Demographics
NPI:1467774430
Name:LIFELINE PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:LIFELINE PHARMACY INCORPORATED
Other - Org Name:MEDSURE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D, R.PH/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:UMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-478-9804
Mailing Address - Street 1:5705 FONDREN RD
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1842
Mailing Address - Country:US
Mailing Address - Phone:713-334-8200
Mailing Address - Fax:713-334-8201
Practice Address - Street 1:5705 FONDREN RD
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1842
Practice Address - Country:US
Practice Address - Phone:713-334-8200
Practice Address - Fax:713-334-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty