Provider Demographics
NPI:1922075985
Name:LIFEOUTCOMES.COM INC.
Entity Type:Organization
Organization Name:LIFEOUTCOMES.COM INC.
Other - Org Name:LIFEOUTCOMES HOME PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:803-791-5098
Mailing Address - Street 1:104 CORPORATE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4600
Mailing Address - Country:US
Mailing Address - Phone:803-791-5098
Mailing Address - Fax:803-791-9669
Practice Address - Street 1:104 CORPORATE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4600
Practice Address - Country:US
Practice Address - Phone:803-791-5098
Practice Address - Fax:803-791-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50007198332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1322580001Medicare ID - Type Unspecified