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General NPI Number Information
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NPI Number | 1336775527
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Entity Type | Organization
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Legal Business Name | LIFELINE PHARMACY 1 LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 2500 W TRENTON ROAD SUITE 12
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-255-5515
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 OVIEDO
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City | BROWNSVILLE
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State | TX
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Zip | 78520-5057
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Country | US
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Telephone | 845-283-7474
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MOBEEN AHMED
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Credential |
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Telephone | 845-283-7474
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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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