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General NPI Number Information
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NPI Number | 1144255357
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Entity Type | Organization
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Legal Business Name | LIFESTREAM PHARMACY INC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 847 EASTON RD
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City | WARRINGTON
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State | PA
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Zip | 18976-2906
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Country | US
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Telephone | 215-491-0999
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Fax | 215-491-0977
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Provider Business Mailing Address
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Address Line | 847 EASTON RD
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City | WARRINGTON
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State | PA
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Zip | 18976-2906
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Country | US
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Telephone | 215-491-0999
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Fax | 215-491-0977
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Authorized Official
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Title or Position | OWNER/PHCY MGR
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Name | DEMETRIOS MELEKOS
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Credential | PHARMACY
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Telephone | 215-491-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481543
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License Number State | PA
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