Provider Demographics
NPI:1700694734
Name:LYFE PHARMACY INC
Entity type:Organization
Organization Name:LYFE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZOKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGMATOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:929-844-9688
Mailing Address - Street 1:10391 LORCA MAJOR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-9024
Mailing Address - Country:US
Mailing Address - Phone:929-844-9688
Mailing Address - Fax:
Practice Address - Street 1:8995 W FLAMINGO RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0441
Practice Address - Country:US
Practice Address - Phone:929-844-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYFE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-23
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy