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General NPI Number Information
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NPI Number | 1225959968
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Entity Type | Organization
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Legal Business Name | LIFEFILL I, LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 12639 W EXPLORER DR STE 125
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City | BOISE
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State | ID
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Zip | 83713-1887
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Country | US
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Telephone | 208-247-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 BROADWAY RM 1910
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City | NEW YORK
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State | NY
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Zip | 10018-2874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EVP, CLOUD AND SPECIALTY PHARMACY
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Name | MICHAEL NAMETH
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Credential |
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Telephone | 646-201-9585
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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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