Provider Demographics
NPI:1609229087
Name:LIFELINERX LLC
Entity Type:Organization
Organization Name:LIFELINERX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENVENISTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-740-8455
Mailing Address - Street 1:1489 N MILITARY TRL STE 113
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1489 N MILITARY TRL STE 113
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6030
Practice Address - Country:US
Practice Address - Phone:561-740-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy