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NPI Code Detail

MEDICARE: LIFELINE PHARMACY INCORPORATED

MEDICARE: LIFELINE PHARMACY INCORPORATED
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

General Provider Information

NPI Number : 1962244657
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFELINE PHARMACY INCORPORATED
Provider Business Mailing Address
First Line : 1807 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3515
Country : US
Telephone Number : 718-304-2211
Fax Number : 718-304-2231
Provider Business Practice Location Address
First Line : 1807 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3515
Country : US
Telephone Number : 718-304-2211
Fax Number : 718-304-2231
Authorized Official
Title or Position : PRESIDENT
Name : SADIA KHAN
Credential :
Telephone Number : 718-304-2211
Provider Enumeration Date : 06/12/2024
Last Update Date : 06/16/2026

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Directions to “LIFELINE PHARMACY INCORPORATED ” Practice Location

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