Healthcare Provider Details

I. General information

NPI: 1710741780
Provider Name (Legal Business Name): LYFE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 W SUNSET RD STE 230
LAS VEGAS NV
89148-4861
US

IV. Provider business mailing address

9280 W SUNSET RD STE 230
LAS VEGAS NV
89148-4861
US

V. Phone/Fax

Practice location:
  • Phone: 702-744-9454
  • Fax:
Mailing address:
  • Phone: 702-744-9454
  • 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: PRESIDENT
Credential: PHARMD
Phone: 702-744-9454