Provider Demographics
NPI:1013234947
Name:LIFE PHARMACY LLC
Entity Type:Organization
Organization Name:LIFE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPUZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-665-5050
Mailing Address - Street 1:23541 WESTHEIMER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3597
Mailing Address - Country:US
Mailing Address - Phone:713-665-5050
Mailing Address - Fax:713-665-5059
Practice Address - Street 1:23541 WESTHEIMER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3597
Practice Address - Country:US
Practice Address - Phone:713-665-5050
Practice Address - Fax:713-665-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146286Medicaid