Healthcare Provider Details

I. General information

NPI: 1285557926
Provider Name (Legal Business Name): LIFEFILL III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3597 E MONARCH SKY LN. SUITE 240 OFC 215
MERIDIAN ID
83646
US

IV. Provider business mailing address

1407 BROADWAY RM 1910
NEW YORK NY
10018-2874
US

V. Phone/Fax

Practice location:
  • Phone: 208-247-3184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NAMETH
Title or Position: EVP, CLOUD AND SPECIALTY PHARMACY
Credential:
Phone: 646-201-9585