Provider Demographics
NPI:1063527265
Name:LIFECHEK RICHMOND LLC
Entity type:Organization
Organization Name:LIFECHEK RICHMOND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-232-3940
Mailing Address - Street 1:109 SHULT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3009
Mailing Address - Country:US
Mailing Address - Phone:979-732-2361
Mailing Address - Fax:979-733-9334
Practice Address - Street 1:109 SHULT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3009
Practice Address - Country:US
Practice Address - Phone:979-732-2361
Practice Address - Fax:979-733-9334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECHEK AUCHAN PARTNERS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX204683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2094706OtherPK
TX470483Medicaid
2094706OtherPK
2094706OtherPK