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General NPI Number Information
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NPI Number | 1790164721
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Entity Type | Organization
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Legal Business Name | LIFELONG PHARMACEUTICALS LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 1707 CHERRY ST
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City | TOLEDO
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State | OH
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Zip | 43608-2857
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Country | US
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Telephone | 419-214-5197
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Fax | 419-214-5199
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Provider Business Mailing Address
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Address Line | 1707 CHERRY ST
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City | TOLEDO
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State | OH
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Zip | 43608-2857
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Country | US
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Telephone | 419-214-5197
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Fax | 419-214-5199
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Authorized Official
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Title or Position | MANAGER
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Name | AL ELOUTA
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Credential |
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Telephone | 419-214-5198
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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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