Provider Demographics
NPI:1912091091
Name:GOOD LIFE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:GOOD LIFE HEALTH SERVICES INC
Other - Org Name:GOOD LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:ANDREESEN
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:308-745-1614
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:LOUP CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68853
Mailing Address - Country:US
Mailing Address - Phone:308-745-1614
Mailing Address - Fax:308-745-0769
Practice Address - Street 1:727 O STREET
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853
Practice Address - Country:US
Practice Address - Phone:308-745-1614
Practice Address - Fax:308-745-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8653183500000X
NE2344333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2815174OtherNCPDP
2815174OtherNCPDP
1120470001Medicare ID - Type Unspecified