Healthcare Provider Details

I. General information

NPI: 1811096605
Provider Name (Legal Business Name): LIFECHEK DENISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S BROADWAY
ELSA TX
78543
US

IV. Provider business mailing address

PO BOX 1167
ELSA TX
78543-1167
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-3361
  • Fax: 956-262-5033
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 TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25740
License Number StateTX

VIII. Authorized Official

Name: BRUCE GINGRICH
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 281-232-3940