Provider Demographics
NPI:1659041085
Name:LIFECARE PHARMACY
Entity Type:Organization
Organization Name:LIFECARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-720-1116
Mailing Address - Street 1:2011 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2521
Mailing Address - Country:US
Mailing Address - Phone:419-720-1116
Mailing Address - Fax:419-386-0984
Practice Address - Street 1:3156 DUSTIN RD STE 101
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4300
Practice Address - Country:US
Practice Address - Phone:419-720-0005
Practice Address - Fax:855-461-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy