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General NPI Number Information
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NPI Number | 1023660875
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Entity Type | Organization
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Legal Business Name | GOODLIFE RX LLC
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 25 N 14TH STREET STE 110
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City | SAN JOSE
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State | CA
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Zip | 95112-6208
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Country | US
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Telephone | 408-294-3219
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Fax | 408-465-0832
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Provider Business Mailing Address
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Address Line | 25 N 14TH STREET STE 110
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City | SAN JOSE
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State | CA
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Zip | 95112-6208
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Country | US
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Telephone | 408-294-3219
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Fax | 408-465-0832
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. THUY MIEN LE
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Credential |
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Telephone | 408-294-3219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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