MEDICARE: LIFELINE PHARMACY INCORPORATED

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	43945	TX

General Provider Information

NPI Number	:	1467774430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE PHARMACY INCORPORATED

Provider Business Mailing Address
First Line	:	5705 FONDREN RD
Second Line	:	101
City	:	HOUSTON
State	:	TX
Zip	:	77036-1842
Country	:	US
Telephone Number	:	713-334-8200
Fax Number	:	713-334-8201

Provider Business Practice Location Address
First Line	:	5705 FONDREN RD
Second Line	:	101
City	:	HOUSTON
State	:	TX
Zip	:	77036-1842
Country	:	US
Telephone Number	:	713-334-8200
Fax Number	:	713-334-8201

Authorized Official
Title or Position	:	PHARM.D, R.PH/DIRECTOR
Name	:	HETTY UMEH
Credential	:
Telephone Number	:	713-478-9804

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	05/06/2010

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