Provider Demographics
NPI:1558816231
Name:NEW LIFE PHARMACY INC
Entity Type:Organization
Organization Name:NEW LIFE PHARMACY INC
Other - Org Name:NEW LIFE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:OKYERE
Authorized Official - Last Name:PREMPEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:305-960-7176
Mailing Address - Street 1:22149 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2840
Mailing Address - Country:US
Mailing Address - Phone:305-960-7176
Mailing Address - Fax:786-953-4472
Practice Address - Street 1:22149 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2840
Practice Address - Country:US
Practice Address - Phone:305-960-7176
Practice Address - Fax:786-953-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH301253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019770300Medicaid
2164231OtherPK