Provider Demographics
NPI:1245012699
Name:LIFE INFUSIONS PHARMA CORP.
Entity type:Organization
Organization Name:LIFE INFUSIONS PHARMA CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-575-2231
Mailing Address - Street 1:19 FAYETTE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4597
Mailing Address - Country:US
Mailing Address - Phone:718-750-9020
Mailing Address - Fax:718-750-9021
Practice Address - Street 1:19 FAYETTE ST FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4597
Practice Address - Country:US
Practice Address - Phone:718-750-9020
Practice Address - Fax:718-750-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy