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General NPI Number Information
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NPI Number | 1467717892
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Entity Type | Organization
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Legal Business Name | LIFEMED PHARMACY LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1249 RIDGEWAY AVE STE Q
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City | ROCHESTER
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State | NY
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Zip | 14615-3761
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Country | US
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Telephone | 847-350-3446
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Fax | 954-748-1170
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Provider Business Mailing Address
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Address Line | 4577 N NOB HILL RAAD SUITE 209
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City | SUNRISE
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State | FL
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Zip | 33351
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Country | US
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Telephone | 847-350-3446
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Fax | 954-748-1170
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Authorized Official
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Title or Position | CEO
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Name | DAVID MAYA
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Credential |
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Telephone | 847-350-3446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 031504
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License Number State | NY
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