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General NPI Number Information
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NPI Number | 1760428684
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Entity Type | Organization
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Legal Business Name | LIFE TREE PHARMACY SERVICES INCORPORATED
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 5 BLUE HERON DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2057
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Country | US
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Telephone | 610-489-6640
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Fax | 610-489-6645
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Provider Business Mailing Address
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Address Line | 5 BLUE HERON DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2057
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Country | US
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Telephone | 610-489-6640
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Fax | 610-489-6645
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK TAGLIANETTI
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Credential |
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Telephone | 610-489-6640
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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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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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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PP481454
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License Number State | PA
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