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NPI Code Detail

MEDICARE: LIFE LINE HEALTH PARTNERS, LLC

MEDICARE: LIFE LINE HEALTH PARTNERS, 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
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336H0001XHome Infusion Therapy Pharmacy
43336S0011XSpecialty Pharmacy
5332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1154678852
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE LINE HEALTH PARTNERS, LLC
Provider Business Mailing Address
First Line : 3740 SAINT JOHNS BLUFF RD S
Second Line : SUITE 3
City : JACKSONVILLE
State : FL
Zip : 32224-2651
Country : US
Telephone Number : 904-730-2223
Fax Number : 904-730-2231
Provider Business Practice Location Address
First Line : 3740 SAINT JOHNS BLUFF RD S
Second Line : SUITE 3
City : JACKSONVILLE
State : FL
Zip : 32224-2651
Country : US
Telephone Number : 904-730-2223
Fax Number : 904-730-2231
Authorized Official
Title or Position : PRESIDENT
Name : MR. RONNIE C DANIEL
Credential : PHARMD
Telephone Number : 904-730-2223
Provider Enumeration Date : 08/13/2012
Last Update Date : 08/13/2012

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Directions to “LIFE LINE HEALTH PARTNERS, LLC ” Practice Location

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