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General NPI Number Information
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NPI Number | 1417918574
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Entity Type | Organization
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Legal Business Name | LIFES CHOICES INC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 420 S ORCHARD ST
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City | BOISE
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State | ID
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Zip | 83705-1238
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Country | US
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Telephone | 208-947-0967
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Fax | 208-947-0967
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Provider Business Mailing Address
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Address Line | 420 S ORCHARD ST
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City | BOISE
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State | ID
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Zip | 83705-1238
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Country | US
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Telephone | 208-947-0967
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Fax | 208-947-0967
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Authorized Official
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Title or Position | CEO
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Name | MARY LANGENFELD
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Credential | RN PHD
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Telephone | 208-947-0967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 1931LS
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License Number State | ID
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