Provider Demographics
NPI:1457589046
Name:LIFESAVER PHARMACY INC
Entity Type:Organization
Organization Name:LIFESAVER PHARMACY INC
Other - Org Name:LIFESAVER PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-385-0059
Mailing Address - Street 1:11735 SW 147TH AVE
Mailing Address - Street 2:#5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3321
Mailing Address - Country:US
Mailing Address - Phone:305-385-0059
Mailing Address - Fax:
Practice Address - Street 1:11735 SW 147TH AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3329
Practice Address - Country:US
Practice Address - Phone:305-385-0059
Practice Address - Fax:305-385-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL241043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006436200Medicaid
2120776OtherPK
6489650001Medicare NSC