Provider Demographics
NPI:1003640343
Name:LIFETIME SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:LIFETIME SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAISHRUTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-867-7150
Mailing Address - Street 1:809 GALLAGHER DR STE J-1
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 GALLAGHER DR STE J-1
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3111
Practice Address - Country:US
Practice Address - Phone:603-867-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy