Healthcare Provider Details

I. General information

NPI: 1871117739
Provider Name (Legal Business Name): MYLYFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ELM ST STE 12
WEST SPRINGFIELD MA
01089-1540
US

IV. Provider business mailing address

PO BOX 931507
ATLANTA GA
31193-1507
US

V. Phone/Fax

Practice location:
  • Phone: 844-469-5933
  • Fax: 844-469-5933
Mailing address:
  • Phone: 844-469-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWARD P KRAMM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 913-515-6719