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General NPI Number Information
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NPI Number | 1154678852
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Entity Type | Organization
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Legal Business Name | LIFE LINE HEALTH PARTNERS, LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 3740 SAINT JOHNS BLUFF RD S SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2651
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Country | US
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Telephone | 904-730-2223
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Fax | 904-730-2231
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Provider Business Mailing Address
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Address Line | 3740 SAINT JOHNS BLUFF RD S SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32224-2651
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Country | US
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Telephone | 904-730-2223
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Fax | 904-730-2231
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RONNIE C DANIEL
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Credential | PHARMD
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Telephone | 904-730-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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