Healthcare Provider Details

I. General information

NPI: 1700694734
Provider Name (Legal Business Name): LYFE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8995 W FLAMINGO RD STE 120
LAS VEGAS NV
89147-0441
US

IV. Provider business mailing address

8995 W FLAMINGO RD STE 120
LAS VEGAS NV
89147-0441
US

V. Phone/Fax

Practice location:
  • Phone: 702-780-4144
  • Fax: 702-780-4503
Mailing address:
  • Phone: 702-780-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAZOKAT NIGMATOVA
Title or Position: OWNER
Credential: PHARMD
Phone: 702-780-4144