Healthcare Provider Details

I. General information

NPI: 1124724364
Provider Name (Legal Business Name): MYRXLIFESTYLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 MARKET ST
BOARDMAN OH
44512-6257
US

IV. Provider business mailing address

8301 MARKET ST
BOARDMAN OH
44512-6257
US

V. Phone/Fax

Practice location:
  • Phone: 330-565-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK LAMONCHA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 330-565-5555