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General NPI Number Information
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NPI Number | 1174321764
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Entity Type | Organization
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Legal Business Name | LIFESPAN PHARMACY, LLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 148 W RIVER ST STE 2B
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City | PROVIDENCE
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State | RI
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Zip | 02904-2615
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Country | US
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Telephone | 401-444-9909
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Fax | 401-444-4095
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Provider Business Mailing Address
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Address Line | 15 LA SALLE SQ
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City | PROVIDENCE
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State | RI
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Zip | 02903-1814
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Country | US
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Telephone | 401-444-2672
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Fax | 401-444-6912
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Authorized Official
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Title or Position | EVP & CFO
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Name | PETER K MARKELL
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Credential |
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Telephone | 401-444-7914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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