Healthcare Provider Details

I. General information

NPI: 1396082442
Provider Name (Legal Business Name): LIFECHEK 336 PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S LOOP 336 W STE 100
CONROE TX
77304-3320
US

IV. Provider business mailing address

PO BOX 1047
RICHMOND TX
77406-0027
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4900
  • Fax: 936-539-4920
Mailing address:
  • Phone: 281-232-3940
  • Fax: 832-595-1203

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 Number28117
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRUCE GINGRICH
Title or Position: MANAGING OFFICER
Credential:
Phone: 281-232-3940