Healthcare Provider Details

I. General information

NPI: 1801962287
Provider Name (Legal Business Name): LIFE SCIENCE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 ROUTE 17M
HARRIMAN NY
10926-3329
US

IV. Provider business mailing address

144 ROUTE 17M
HARRIMAN NY
10926-3329
US

V. Phone/Fax

Practice location:
  • Phone: 845-781-7613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number030700
License Number StateNY

VIII. Authorized Official

Name: SCOTT BERLINER
Title or Position: PHARMACIST
Credential:
Phone: 845-781-7613