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General NPI Number Information
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NPI Number | 1548194087
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Entity Type | Organization
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Legal Business Name | LIFESPAN PHARMACY, LLC
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 200 CORLISS ST STE 2A
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City | PROVIDENCE
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State | RI
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Zip | 02904-2602
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Country | US
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Telephone | 401-606-3500
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Fax | 401-606-3599
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Provider Business Mailing Address
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Address Line | 15 LA SALLE SQ
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City | PROVIDENCE
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State | RI
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Zip | 02903-1814
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Country | US
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Telephone | 401-444-6779
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Fax | 401-444-6912
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Authorized Official
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Title or Position | EVP & CFO
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Name | PETER K MARKELL
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Credential |
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Telephone | 401-444-7914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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