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General NPI Number Information
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NPI Number | 1356163752
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Entity Type | Organization
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Legal Business Name | INFINITY LIFESTYLE MEDICINE
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2115 W 38TH ST
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City | ERIE
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State | PA
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Zip | 16508-1925
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Country | US
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Telephone | 814-304-8560
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Fax | 814-352-9022
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Provider Business Mailing Address
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Address Line | 2115 W 38TH ST
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City | ERIE
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State | PA
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Zip | 16508-1925
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Country | US
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Telephone | 814-304-8560
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Fax | 814-352-9022
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JUSTIN SCHOLL
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Credential | PHARMD
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Telephone | 814-304-8560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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