Provider Demographics
NPI:1336254531
Name:LIFECHEK CONROE LLC
Entity Type:Organization
Organization Name:LIFECHEK CONROE LLC
Other - Org Name:WELLMEDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-673-1523
Mailing Address - Street 1:1316 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-3531
Mailing Address - Country:US
Mailing Address - Phone:855-987-7333
Mailing Address - Fax:855-886-6286
Practice Address - Street 1:1316 7TH ST
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-3531
Practice Address - Country:US
Practice Address - Phone:281-232-2850
Practice Address - Fax:281-232-2851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX242643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145573Medicaid
2092990OtherPK