Healthcare Provider Details

I. General information

NPI: 1144255357
Provider Name (Legal Business Name): LIFESTREAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 EASTON RD
WARRINGTON PA
18976-2906
US

IV. Provider business mailing address

847 EASTON RD
WARRINGTON PA
18976-2906
US

V. Phone/Fax

Practice location:
  • Phone: 215-491-0999
  • Fax: 215-491-0977
Mailing address:
  • Phone: 215-491-0999
  • Fax: 215-491-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481543
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIOS MELEKOS
Title or Position: OWNER/PHCY MGR
Credential: PHARMACY
Phone: 215-491-0999