Provider Demographics
NPI:1801962287
Name:LIFE SCIENCE PHARMACY INC.
Entity type:Organization
Organization Name:LIFE SCIENCE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-781-7613
Mailing Address - Street 1:144 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3329
Practice Address - Country:US
Practice Address - Phone:845-781-7613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307001835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258804Medicaid