MEDICARE: LIFE WATCH 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy	4712	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2136090	OTHER		PK

General Provider Information

NPI Number	:	1386948834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE WATCH PHARMACY LLC

Provider Business Mailing Address
First Line	:	1 BURTON HILLS BLVD
Second Line	:	SUITE 215
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6293
Country	:	US
Telephone Number	:	615-884-0302
Fax Number	:	888-208-1097

Provider Business Practice Location Address
First Line	:	1838 ELM HILL PIKE STE 126
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-3702
Country	:	US
Telephone Number	:	615-884-0302
Fax Number	:	888-208-1097

Authorized Official
Title or Position	:	MEMBER
Name	:	ANDREW MILLER
Credential	:
Telephone Number	:	800-940-4901

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	01/13/2015

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Directions to “LIFE WATCH PHARMACY LLC ” Practice Location

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