MEDICARE: LIFEFIRST PHARMACY

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	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	PH02475	NV

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
2	2118837	OTHER		PK

General Provider Information

NPI Number	:	1760621155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEFIRST PHARMACY

Provider Business Mailing Address
First Line	:	2407 W CHARLESTON BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2138
Country	:	US
Telephone Number	:	702-646-5433
Fax Number	:	702-646-1696

Provider Business Practice Location Address
First Line	:	2407 W CHARLESTON BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2138
Country	:	US
Telephone Number	:	702-646-5433
Fax Number	:	702-646-1696

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	GERALDINE OBIAJULU
Credential	:
Telephone Number	:	702-646-5433

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	01/18/2017

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Directions to “LIFEFIRST PHARMACY ” Practice Location

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