Healthcare Provider Details

I. General information

NPI: 1760621155
Provider Name (Legal Business Name): LIFEFIRST PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 W CHARLESTON BLVD STE 110
LAS VEGAS NV
89102-2138
US

IV. Provider business mailing address

2407 W CHARLESTON BLVD STE 110
LAS VEGAS NV
89102-2138
US

V. Phone/Fax

Practice location:
  • Phone: 702-646-5433
  • Fax: 702-646-1696
Mailing address:
  • Phone: 702-646-5433
  • Fax: 702-646-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH02475
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GERALDINE OBIAJULU
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 702-646-5433