Provider Demographics
NPI:1831998467
Name:LIFETIME PHARMACY, LLC
Entity type:Organization
Organization Name:LIFETIME PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:574-318-4195
Mailing Address - Street 1:19120 OAKMONT SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3529
Mailing Address - Country:US
Mailing Address - Phone:313-828-2794
Mailing Address - Fax:
Practice Address - Street 1:212 W EDISON RD STE A
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8301
Practice Address - Country:US
Practice Address - Phone:574-318-4195
Practice Address - Fax:574-318-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy