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General NPI Number Information
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NPI Number | 1467530873
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Entity Type | Organization
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Legal Business Name | LIFE EXTENSION PHARMACY INC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 5990 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-2633
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Country | US
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Telephone | 877-877-9700
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Fax | 877-877-9708
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Provider Business Mailing Address
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Address Line | 3600 W COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3338
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Country | US
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Telephone | 954-202-7729
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Fax | 954-202-7729
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Authorized Official
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Title or Position | PARALEGAL
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Name | MELANIE KAMBURIAN
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Credential | PHARMACIST
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Telephone | 954-202-7729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH22301
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License Number State | FL
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