MEDICARE: LIFETIME SPECIALTY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1003640343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME SPECIALTY PHARMACY LLC

Provider Business Mailing Address
First Line	:	809 GALLAGHER DR STE J-1
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 GALLAGHER DR STE J-1
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3111
Country	:	US
Telephone Number	:	603-867-7150
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	SAISHRUTHI SESHAM
Credential	:
Telephone Number	:	603-867-7150

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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