Provider Demographics
NPI:1568004026
Name:LIFETREE CLINICAL RESEARCH LC.
Entity Type:Organization
Organization Name:LIFETREE CLINICAL RESEARCH LC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-904-4506
Mailing Address - Street 1:1255 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1365
Mailing Address - Country:US
Mailing Address - Phone:801-904-4555
Mailing Address - Fax:
Practice Address - Street 1:1255 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1365
Practice Address - Country:US
Practice Address - Phone:801-904-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RACHEL AKIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy