MEDICARE: LIFE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	047043-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275673923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE PHARMACY INC

Provider Business Mailing Address
First Line	:	4301 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1429
Country	:	US
Telephone Number	:	718-438-1421
Fax Number	:	718-438-1483

Provider Business Practice Location Address
First Line	:	4301 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1429
Country	:	US
Telephone Number	:	718-438-1421
Fax Number	:	718-438-1483

Authorized Official
Title or Position	:	PHARMACIST
Name	:	ELAN GUTMAN
Credential	:
Telephone Number	:	718-438-1421

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/05/2025

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Directions to “LIFE PHARMACY INC ” Practice Location

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