Healthcare Provider Details

I. General information

NPI: 1295777928
Provider Name (Legal Business Name): LIFECHEK CARRIZO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 TOWN CENTER BLVD S STE 103
SUGAR LAND TX
77479-2591
US

IV. Provider business mailing address

314 N 5TH ST SUITE B
CARRIZO SPRINGS TX
78834-3106
US

V. Phone/Fax

Practice location:
  • Phone: 844-843-0101
  • Fax: 844-843-0101
Mailing address:
  • Phone: 830-876-2516
  • Fax: 830-876-5450

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 Number28438
License Number StateTX

VIII. Authorized Official

Name: SHAILENDRA GUPTA
Title or Position: MANAGING OFFICER
Credential:
Phone: 832-290-8997