Provider Demographics
NPI:1619448248
Name:NULIFE PHARMACY, INC
Entity Type:Organization
Organization Name:NULIFE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGADEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANJANAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-769-7941
Mailing Address - Street 1:14150 TRINITY BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2597
Mailing Address - Country:US
Mailing Address - Phone:817-769-7941
Mailing Address - Fax:817-769-8332
Practice Address - Street 1:14150 TRINITY BLVD STE 750
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-2597
Practice Address - Country:US
Practice Address - Phone:817-769-7941
Practice Address - Fax:817-769-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy