Provider Demographics
NPI:1770778722
Name:LIFE RX LLC
Entity type:Organization
Organization Name:LIFE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DUMISANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBI-SHAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MSTOM
Authorized Official - Phone:212-447-0750
Mailing Address - Street 1:45 E 33RD ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5336
Mailing Address - Country:US
Mailing Address - Phone:212-447-0750
Mailing Address - Fax:212-447-0751
Practice Address - Street 1:45 E 33RD ST
Practice Address - Street 2:SUITE 604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5336
Practice Address - Country:US
Practice Address - Phone:212-447-0750
Practice Address - Fax:212-447-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003586171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty