Healthcare Provider Details

I. General information

NPI: 1659572097
Provider Name (Legal Business Name): LIFECHEK SWEENY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST
SWEENY TX
77480
US

IV. Provider business mailing address

200 N. MAIN ST
SWEENY TX
77480
US

V. Phone/Fax

Practice location:
  • Phone: 979-548-0212
  • Fax: 979-548-0116
Mailing address:
  • Phone: 979-548-0212
  • Fax: 979-548-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25569
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: COLIN GINGRICH
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 281-232-3940