Provider Demographics
NPI:1659572097
Name:LIFECHEK SWEENY LLC
Entity Type:Organization
Organization Name:LIFECHEK SWEENY LLC
Other - Org Name:LIFECHEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:200 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480
Mailing Address - Country:US
Mailing Address - Phone:979-548-0212
Mailing Address - Fax:979-548-0116
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480
Practice Address - Country:US
Practice Address - Phone:979-548-0212
Practice Address - Fax:979-548-0116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255693336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100169OtherPK
TX470313Medicaid
2100169OtherPK