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General NPI Number Information
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NPI Number | 1437672797
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Entity Type | Organization
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Legal Business Name | LIFE CHANGE RX LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 1844 S 15TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53204-3225
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Country | US
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Telephone | 414-335-4617
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Fax | 414-751-5146
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Provider Business Mailing Address
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Address Line | 7115 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53216-2051
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Country | US
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Telephone | 414-600-2000
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Fax | 414-600-0414
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED EL SHEIKH
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Credential | RPH
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Telephone | 414-335-4617
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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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