Provider Demographics
NPI:1104410935
Name:LIFESPAN PHARMACY, LLC
Entity type:Organization
Organization Name:LIFESPAN PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-444-7914
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-7914
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:11 FRIENDSHIP STREET
Practice Address - Street 2:SHEFFIELD BLDG., 1ST FLOOR
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-0284
Practice Address - Country:US
Practice Address - Phone:401-845-1100
Practice Address - Fax:401-845-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0002XSuppliersPharmacyClinic Pharmacy